Effects of Endolymphatic Sac Drainage With Steroids for Meniere’s Disease (EDSS)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00500474
Recruitment Status : Completed
First Posted : July 12, 2007
Last Update Posted : July 25, 2007
Information provided by:
Osaka University

Brief Summary:
Meniere's disease is a common inner ear disease with an incidence of 15-50 per 100,000 population. Since Meniere’s disease is thought to be triggered by an immune insult to inner ear, we examined intra-endolymphatic sac application of large doses of steroids as de novo treatment for intractable Meniere’s disease.

Condition or disease Intervention/treatment Phase
Meniere's Disease Procedure: endolymphatic sac drainage with steroids Not Applicable

Detailed Description:

Meniere's disease characterized by recurrent attacks of vertigo, fluctuating hearing loss and tinnitus, is a common disease with an incidence of 15-50 per 100,000 population. Some patients with Meniere's disease are strongly prevented from participating in activities of daily life and interaction with their social environment, such as work and schooling, due to frequent attacks of vertigo especially with progressive sensorineural hearing loss, in spite of various kinds of medication. This type of Meniere’s disease is called intractable Meniere’s disease. Although the oto-pathology in Meniere’s temporal bones was revealed in 1938 to be inner ear endolymphatic hydrops, the definitive pathogenesis of Meniere’s disease is still unknown and there is no radical treatment for this disease.

It has, however, been reported that Meniere's disease is usually triggered by immune, metabolic, infectious, traumatic or other insults to the inner ear, associated with a small misplaced malfunctioning endolymphatic sac. Among these insults, immune-mediated responses in the inner ear endo-organs such as the endolymphatic sac, stria vascularis and spiral ligament, are thought to be the main reason for the development of symptoms in Meniere’s disease. Thus, systemic administration and/or local perfusion of corticosteroids into the middle ear have been adopted as an anti-immune or anti-inflammatory therapy for patients with intractable Meniere's disease. These treatments were reported to result in good relief from vertigo and improvement of hearing in some cases. However, these results especially for hearing did not last long enough to discontinue additional repetitive applications of steroids. Since Meniere's disease is characterized by repeated attacks of vertigo with fluctuating and/or progressive hearing loss unlike other inner ear diseases without recurrence such as sudden deafness and vestibular neuritis, it is necessary to refrain from repetitive applications of steroids for the long-term follow-up with Meniere's patients because of side effects.

For inner ear drug delivery, we noted another hopeful but unevaluated route, the longitudinal route from the endolymphatic sac to the cochlea and vestibule, suggested by several lines of evidence in animal studies. Morgenstern et al. and Lee et al. demonstrated that the intra-endolymphatic sac materials could reach the cochlear endolymphatic site through the vestibular aqueduct using a test marker and an oto-toxic drug, respectively. Recently, Yamasoba et al. suggested the possibility of gene therapy through the vestibular aqueduct route. We also revealed that intra-endolymphatic sac steroids could up-regulate a water channel molecule, aquaporin-3 mRNA in the cochlea.

In the present study, we examined the intra-endolymphatic sac application of large doses of steroids as de novo treatment for intractable Meniere's disease.

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 197 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single
Primary Purpose: Treatment
Official Title: Clinical Study of Endolymphatic Sac Drainage With or Without Steroids for Intractable Meniere's Disease
Study Start Date : April 1996
Actual Study Completion Date : March 2005

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Primary Outcome Measures :
  1. the ratio of patients in vertigo supression and hearing improvement [ Time Frame: post-operative 2-7 years ]

Secondary Outcome Measures :
  1. the ratio of patients in canal improvement [ Time Frame: post-operative 2 years ]

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Ages Eligible for Study:   Child, Adult, Older Adult
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Clinical diagnosis of Meniere's Disease, who did not respond to various forms of medical and psychological managements for at least 6 months, i.e. intractable Meniere's disease.

Exclusion Criteria:

  • Other known causes of vertigo including central lesion

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To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT00500474

Department of Otolaryngology, Osaka University, School of Medicine
Suita-city, Osaka, Japan, 565-0871
Sponsors and Collaborators
Osaka University
Principal Investigator: Tadashi Kitahara, M.D.,Ph.D. Department of Otolaryngology, Osaka University, School of Medicine

Publications automatically indexed to this study by Identifier (NCT Number): Identifier: NCT00500474     History of Changes
Other Study ID Numbers: tk19661217
First Posted: July 12, 2007    Key Record Dates
Last Update Posted: July 25, 2007
Last Verified: July 2007

Keywords provided by Osaka University:
Meniere's disease
inner ear
endolymphatic sac drainage
declined surgery
natural course
Efficacy of steroids via endolymphatic sac
for intractable Meniere's disease

Additional relevant MeSH terms:
Meniere Disease
Endolymphatic Hydrops
Labyrinth Diseases
Ear Diseases
Otorhinolaryngologic Diseases