Imperial College London
Alternate

Dr Qadeer Arshad

Faculty of Medicine, Faculty of Medicine Centre

Honorary Clinical Senior Lecturer
 
 
 
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Contact

 

+44 (0)20 3313 5527q.arshad

 
 
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Location

 

Lab BlockCharing Cross Campus

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Summary

 

Publications

Citation

BibTex format

@article{Patel:2016,
author = {Patel, M and Agarwal, K and Arshad, Q and Hariri, M and Rea, P and Seemungal, BM and Golding, JF and Harcourt, JP and Bronstein, AM},
journal = {Lancet},
title = {Intratympanic steroids vs. gentamicin in unilateral Ménière's disease: a randomised double-blind comparative effectiveness trial},
url = {http://hdl.handle.net/10044/1/40870},
year = {2016}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - Background: Ménière’s disease (MD) is characterised by severe vertigo attacks and deafness. Intratympanic gentamicin ablates vestibular function, quells vertigo and is the standard treatment for refractory MD - but it can worsen hearing. Intratympanic corticosteroids may reduce vertigo without harming hearing but no RCT comparing steroids versus gentamicin is available.Methods: In this comparative effectiveness trial, refractory unilateral MD patients, defined according to the American Academy of Otolaryngology, were double-blindly randomised (1:1 block-design) to intratympanic methylprednisolone (n=30, 62·5mg/ml) or gentamicin (n=30, 40mg/ml) and followed-up over two years at Charing Cross Hospital (Imperial NHS, London) and Leicester Royal Infirmary, Leicester, UK. Primary outcome was vertigo frequency over the final 6-months (18-24months post-injection) compared to a 6-month pre-injection baseline. Secondary outcomes were vestibular and auditory symptoms (validated questionnaires) and hearing preservation (audiometry). ClinicalTrials.gov:NCT00802529.Findings: For intention-to-treat analysis i.e., all 60 patients, number of vertigo attacks/6months (primary outcome) fell from 19·9 to 2·5 [87%] in the gentamicin arm and 16·4 to 1·6 [90%] in the steroid arm (difference in absolute number of attacks in the final 6months -0·9; 95%CI -3·4 to 1·6). Both drugs reduced the number of vertigo attacks at 2 years (P<0·0001), with equal efficacy (P=0·51). For hearing preservation (secondary outcome), there was no difference (P=0·18) between drugs for hearing thresholds (final difference -2·45decibels, 95%CI -13·4 to 8·5). Both drugs reduced auditory and vestibular symptoms equally. As protocol, patients whose vertigo did not respond post-injection (‘non-responders’) were considered for additional injections by an unblinded physician (8 patients ge
AU  - Patel,M
AU  - Agarwal,K
AU  - Arshad,Q
AU  - Hariri,M
AU  - Rea,P
AU  - Seemungal,BM
AU  - Golding,JF
AU  - Harcourt,JP
AU  - Bronstein,AM
PY  - 2016///
SN  - 1474-547X
TI  - Intratympanic steroids vs. gentamicin in unilateral Ménière's disease: a randomised double-blind comparative effectiveness trial
T2  - Lancet
UR  - http://hdl.handle.net/10044/1/40870
ER  -
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