Table 1. Baseline demographic characteristics of the patients in the included studies based on treatment groups (1; 2; 3).
| Author (Publication Year) | N | Age in years | Sex | Affected ear | Initial PTA | MD duration in years; (n); mean±SD; median (range) | MD Stage: I, II, II, IV (n) | Vertigo class (n); vertigo frequency / month mean±SD |
|---|---|---|---|---|---|---|---|---|
| Treatment Groups | mean±SD; median (range) | (F) | (Rt: Lt) | mean±SD; level (n) | ||||
| Bojrab (2018) [35] | ||||||||
| Group 1: Endolymphatic sac decompression surgery (ESD) + Steroid injection | 18 | 56.7 ± 9.5 | NR | NR | 45.5 ± 17.4* | NR | NR | 3.3±NR |
| Group 2: ESD | 17 | 51.8 ± 10.6 | NR | NR | 39.9 ±16.5* | NR | NR | 3.4±NR |
| Kitahara (2016) [39] | ||||||||
| Group 1: Tympanic ventilation tube + medication (including Diuretics, Betahistine, Diphenidol, Dimenhydrinate, and Diazepam) | 63 | 51.7 ± 14.7 | 41 | 31:32:00 | 49.5 ± 13.2** | 3.1±1.7 | NR | 1.8 ±1.1** |
| Group 2: medication (including diuretics, Betahistine, Diphenidol, Dimenhydrinate, and Diazepam) | 70 | 49.7 ± 16.5 | 45 | 31:39:00 | 47.3 ± 13.4** | 2.5±1.9 | NR | 1.6±1** |
| Masoumi (2017) [36] | ≤25(20), | A (0), B (27), C (9); | ||||||
| Group 1: IT dexamethasone | 36 | 39.9±13.84 | 15 | 22;14 | 26-40(11), 41-70(5); |
4.54±1.98 | NR | A (0), B (20), C (13) |
| Group 2: IT methylprednisolone | 33 | 41.51±11.68 | 15 | 16:17 | ≤25(15), 26-40(15), 41-70(3) |
4.06±3.12 | NR | |
| Paragache (2005) [37] | ||||||||
| Group 1: IT Dexamethasone | 20 | 38.5 (24–56) | 7 | NR | NR | NR | NR | NR |
| Group 2: Conventional medical treatment (salt and caffeine restricted diet, and nicotine and alcohol restrictions, cinnarizine 25 mg three times a day for acute episodes, and betahistine 16 mg three times a day for maintenance therapy) | 20 | 40.3 (17–78) | 7 | NR | NR | NR | NR | NR |
| Albu (2015) [42] | II: 5, III: 20, | |||||||
| Group 1: IT Dexamethasone +placebo pills | 30 | 50.2 ± 14.3 | 23 | NR | 57.4 ± 14.7 | NR | IV: 8; | 8.6±NR |
| Group 2: Betahistine + IT placebo (saline) | 29 | 51.5 ± 14.3 | 20 | NR | 58.2 ± 13.9 | NR | II: 7, III: 21, IV: 5 | 7.9±NR |
| Patel (2016) [38] | ||||||||
| Group 1: IT Methylprednisolone | 30 | 51·6 ± 10·2 | 10 | 13:17 | 53.3 ±21.2 | 4.1 ±3.2 | NR | 5.5±6.5 |
| Group 2: IT Gentamicin | 30 | 53·3 ± 10·8 | 15 | 12:18 | 51.5 ±11.3 | 4.9 ±5.6 | NR | 6.9±16.7 |
| Casani (2012) [44] | ||||||||
| Group 1: IT Dexamethasone | 26 | 53.7±12.9 | 18 | NR | 56.5 ± 13.4 | 1.43±0.6 | NR | NR |
| Group 2: IT Gentamicin | 31 | 54.2±12.9 | 21 | NR | 58.7 ± 13.3 | 1.45±0.59 | NR | NR |
| Albu (2016) [40] | II: 6, III: 18, | |||||||
| Group 1: ITD (Dexamethasone) +placebo | 32 | NR | 21 | NR | 51.4± 13.6 | NR | IV: 9; | 7.5±NR |
| Group 2: ITD (Dexamethasone)+ high dosage betahistine (HDBH) | 30 | NR | 18 | NR | 54.6± 15.2 | NR | II: 7, III: 19, IV: 7 | 6.7±NR |
| Bremer (2014) [43] | Rt ear:59± 8.6 | |||||||
| Group 1: IT Gentamicin | 5 | 64.5±8 | 2 | NR | Lt ear: 46.8±21.3; | 3.1 (1.1–19.6) | NR | NR |
| Rt ear:29.7± 7.4, Lt ear: 61.3±30.7; | ||||||||
| Group 2: IT Gentamicin+placebo | 5 | 72.6±5 | 0 | NR | Rt ear:35± 24.5, Lt ear: 43.8±21.6 | 3.3 (0.7–7.5) | NR | NR |
| Group 3: placebo | 4 | 57.3±16.7 | 4 | NR | 2.5 (0.1–18.2) | NR | NR | |
| Postema (2008) [46] | Diseased ear: 56 | Vertigo score***: 2.1±0.8; | ||||||
| Group 1: IT gentamicin | 16 | 55(NR-NR) | NR | NR | Contralateral ear:16 | NR | NR | 2.0±0.8 |
| Group 2: Placebo | Diseased ear: 53 | |||||||
| 12 | 53(NR-NR) | NR | NR | Contralateral ear:18 | NR | NR | ||
| Ganança (2009) [45] | ||||||||
| Group 1: Low-dose betahistine (16 mg tid) | 60 | 45.9±13.3 | 37 | NR | NR | 1.4±NR; 12(2–48) □ |
NR | 76.6% † |
| Group 2: High-dose betahistine (24 mg bid) | 60 | 45.4±13.8 | 36 | NR | NR | 1.34±NR 14(4–48) □ |
NR | 73.4% † |
| Saliba (2015) [57] | ||||||||
| Group 1: Endolymphatic duct blockage (EDB) | 35 | 47.2±NR | 21 | NR | 50.9±30.2 | NR | NR | 8.37±5.8 ǂ |
| Group 2: Endolymphatic sac decompression (ESD) | 22 | 53.5±NR | 13 | NR | 55.8±23.9 | NR | NR | 9.64±7.9 ǂ |
| Garduño-Anaya (2005) [49] | ||||||||
| Group 1: IT Dexamethasone | 11 | Overall mean: 50; median 48 (range 28–77) | 16 | Overall: 10:12 | 55.7±NR | Overall mean: 6.9; median 5 (range 3–30) | NR | 0.87±0.61 |
| Group 2: Placebo | 7 | (all) | 56.6±NR | NR | 1.03±0.80 | |||
| Stokroos & Kingma (2004) [50] | 9 | |||||||
| Group 1: IT Gentamicin | 12 | 59 (34–74) | (all) | Overall: 8:14 | 60±18.7 ∫ | NR | NR | 74±114 ‡ |
| Group 2: Placebo | 10 | 58 (45–70) | 53±16.5 ∫ | NR | NR | 25±31 ‡ | ||
| ElBeltagy (2012) [51] | 11 | Overall: 43.8±63.8 in last 6 months | ||||||
| Group 1: IT Gentamicin | 15 | Overall: 42 (29–57) | (all) | Overall: 19:11 | 57.7±10.6 | Overall: 4±4.9; range 1–17 | NR | |
| Group 2: IT Dexamethasone | 15 | 47.5±8.33 | NR | |||||
| Kitahara (2008) [47] | I:4, II: 18, III: 60, IV: 18 | |||||||
| Group 1: Endolymphatic sac drainage + steroid instillation into the sac | 100 | 50.3± 14.5 | 56 | NR | NR | 8.7±7.5 | I:3, II: 5, III: 32, IV: 7; | 3.8±2.3 |
| Group 2: Endolymphatic sac drainage without steroid instillation into the sac | I: 3, II: 8, III: 27, IV: 12 | |||||||
| Group 3: Medical managements included diuretics, betahistine, diphenidol, dimenhydrinate, and diazepam | 47 | 55.6± 10.1 | 26 | NR | NR | 9.5±8.9 | 3.9±2.6 | |
| 50 | 53.7± 12.4 | 26 | NR | NR | 8.8±6.2 | 3.6±2.3 | ||
| Adrion (2016) [41] | ||||||||
| Group 1: Low-dose betahistine | 70 | 56.1± 11.1 | 34 | 28:21:00 | NR | NR | NR | NR |
| Group 2: High-dose betahistine | 72 | 56.1± 12.6 | 39 | 24:25:00 | NR | NR | NR | NR |
| Group 3: Placebo | 72 | 54.5± 12.8 | 39 | 28:25:00 | NR | NR | NR | NR |
| Morales-Luckie (2005) [48] | ||||||||
| Group 1: Oral Prednisolone: [Prednisolone + diphenidol + acetazolamide + low-sodium diet (< 1,500 mg/d)] | 8 | 40.8 (33–47) | NR | NR | NR | 3.6 | NR | C:8 |
| Group 2: maintenance therapy: diphenidol + acetazolamide + low-sodium diet (< 1,500 mg/d) | 8 | 38.8 (32–49) | NR | NR | NR | 3.3 | NR | C:8 |
* SE (standard error)
** six months before the start of treatment
*** vertigo scores based on a form to score vertigo on a four-point scale: severe (3), moderate (2), mild (1) and none (0).
∫ extended Fletcher index (dB) at 500, 1000, 2000 and 4000 Hz (AAO-HNS stage 3–4) before treatment
∫∫ data was not reported for MD patients separately.
† percent of patients have ≥ 2 spells of vertigo lasting≥ 1 hour: 76.6% at baseline.
‡ number of attacks per year
ǂ number of spells patient reported for the last 6 months before the surgery
□ data shown in months
Abbreviations: A = Complete control of definitive spells (numeric value 0–40); B = Limited control of definitive spells (numeric value 41–80); C = Insignificant control of definitive spells (numeric value 81–120); /d = per day; F = female; IT = intratympanic; L = left; Lt = left; M (SD) = Mean and standard deviation; M (range) = Median or Mean (range); mg = milligram; N = sample size analyzed; NR = not reported; PTA = pure tone average; R = right; Rt = right; & = and.