piperidines and Meniere-Disease

Meniere's disease is a common inner ear disease with an incidence of 15 to 50 per 100,000 population. Since Meniere's disease is thought to be triggered by an immune insult to the inner ear, we examined intraendolymphatic sac application of steroids as a new therapeutic strategy for intractable Meniere's disease.. Prospective randomized controlled study.. Between 1996 and 2005, we enrolled and assigned 197 intractable Meniere's patients to three groups in a randomized controlled trial: Group I (G-I)- patients who underwent endolymphatic sac drainage and steroid-instillation; Group II (G-II)-those who underwent endolymphatic sac drainage without steroid-instillation; and Group III (G-III)-those who declined endolymphatic sac drainage. Definitive spells and hearing in all three groups were determined for 2 to 7 years after treatment.. According to the 1995 American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) criteria, 2-year results demonstrated that vertigo was completely controlled in 88.0% of patients in G-I (n = 100), 85.1% of patients in G-II (n = 47), and 8.0% in G-III (n = 50). Statistically, G-I = G-II>G-III. Hearing was improved in 49.0% of patients in G-I, 31.9% in G-II, and 6.0% in G-III (G-I>G-II>G-III). Results after 7 years showed that vertigo was completely controlled in 78.8% of patients in G-I, 79.2% in G-II, and 25.0% in G-III (G-I = G-II>G-III). Hearing improved in 36.5% of patients in G-I, 8.3% in G-II, and 0.0% in G-III (G-I>G-II = G-III).. From non-surgical observation in G-III for at least 7 years after treatment, steroids instilled into endolymphatic sac in G-I patients significantly improved hearing in intractable Meniere's patients, more so than endolymphatic sac drainage without steroids in G-II patients.

Topics: Anti-Inflammatory Agents; Antidepressive Agents; Dexamethasone; Diazepam; Dimenhydrinate; Diuretics; Endolymphatic Sac; Female; Follow-Up Studies; Histamine H1 Antagonists; Humans; Male; Meniere Disease; Middle Aged; Piperidines; Prospective Studies

In 24 patients with Ménière's disease, chemotherapy using Diphenidol (1,1-diphenyl-4-piperidino-l-butanol hydrochloride), a non-phenothiazinic antiemetic agent, was carried out using the double-blind technique in the cross-over design. The prevalence and intensity of symptoms at the three stages were recorded every three weeks according to fixed scales which were graded: vertigo, unsteadiness, tinnitus, nausea, headache, and shoulder stiffness. The hearing was measured by tone audiometry. Equilibrium function tests were also performed every three weeks and these included the electronystagmographical procedure to determine caloric response and the ARG-Tilt tests. Both symptoms and the results of equilibrium function tests, showed a higher incidence of improvement during the period of Diphenidol administration than during that of placebo. The difference was statistically significant with respect to vertigo, dizziness or unsteadiness, and general condition subjectively, as well as caloric response and ARG-Tilt tests. The Diphenidol effect consisted of an improvement of imbalance, both in the peripheral and in the central vestibular system through its neural and circulatory action. Only 8% of the patients dropped out and no side effects were observed in this series. Both the feasibility of the graded symptom scales and the utility of each parameter obtained from the equilibrium function tests are discussed in connection with testing of the drug in various stages of the disease.

Topics: Audiometry; Clinical Trials as Topic; Eye Movements; Hearing; Humans; Meniere Disease; Piperidines; Placebos; Postural Balance; Vestibular Function Tests

Topics: Adolescent; Adult; Audiometry; Caloric Tests; Diet, Sodium-Restricted; Diuretics; Female; Humans; Male; Meniere Disease; Middle Aged; Piperidines; Vasodilator Agents