Intervention Outcomes for Meniere's Disease: An Umbrella Review.

Abstract

To assess and summarize the outcomes of major pharmacologic, device-based, and surgical interventions reported in systematic reviews and meta-analyses for the treatment of Meniere's disease. CINAHL, Cochrane, PubMed, Scopus. Twenty-two systematic reviews with meta-analyses of randomized and nonrandomized studies were identified, assessing interventions including gentamicin, corticosteroids, betahistine, positive pressure therapy, adjunctive acupuncture, endolymphatic sac decompression, and cochlear implantation. The review was reported in accordance with PRISMA 2020 and PRISMA-S, and methods followed Cochrane Handbook guidance. Four investigators extracted data. When possible, data were pooled using a random-effects model. Outcomes included vertigo control, tinnitus improvement, and adverse events. Intratympanic gentamicin showed the highest vertigo control rate (89%) but carried a mild hearing loss risk and a 23% subjective hearing reduction rate. Intratympanic steroids offered modest benefit with fewer auditory risks. Positive pressure therapy showed mixed results, while acupuncture demonstrated symptomatic benefit when combined with other therapies. Endolymphatic sac decompression achieved 75%-82% control of vertigo initially but declined over time. Cochlear implants improved speech perception and tinnitus in profound hearing loss. No eligible meta-analyses evaluated antivirals, ventilation tubes, vestibular nerve section, or labyrinthectomy. Intratympanic gentamicin provides the strongest vertigo control but is backed by low-quality evidence and risks hearing loss. Conservative treatments like intratympanic steroids and betahistine show modest benefit with mixed evidence. Adjunctive options like acupuncture require cautious interpretation due to low-quality evidence. Surgical and device-based options demonstrate variable effectiveness, highlighting the need for individualized, symptom-driven care and further high-quality trials.