This is a very important and much underestimated aspect in the management of Menieres disease. This can help minimize stressors which act as a trigger to acute attacks, and can also help in the management of underlying tinnitus, dizziness and imbalance. A syndrome labeled psychophysiologic dizziness plays a large role in many patients with Meniere’s Disease. This essentially where an insult to the vestibular system leaves a degree of nerve damage. The brain needs to compensate for this loss and anxiety, especially anxiety centred on the fear of further attacks or dizziness can further amplify the symptoms of instability.
Depending on timing, intra-tympanic steroid injection is also offered (dexamethasone 10-24mg/cc). Intra-typmpanic steroid injection is performed by inserting a needle through the eardrum and injecting about of highly concentrated steroids directly into the middle ear space. The patient is than instructed to keep the affected ear up for 30 minutes without swallowing, yawning, or popping the ear. After injection, the patient is allowed to immediately resume normal activities. This steroid injection has also been used to treat Meniere's Disease flare-ups.
Clinically, the success rate of Intratympanic steroid therapy in patients with SHL is variable in the literature and the available studies are limited to retrospective and non-controlled prospective ones. In those studies steroids were used in various concentrations, regimens and delivery methods and their effectiveness have not been established due to the lack of randomized controlled trials. There have been some studies in the literature that discussed the effectiveness of Intratympanic steroid therapy as a salvage mode of therapy in patients who failed to respond to oral steroids (Herr & Marzo 2005, Slattery et al 2005).