Menière's disease.

INTRODUCTION: Menière's disease causes recurrent vertigo, hearing loss, tinnitus, and fullness or pressure in the ear, which mainly affects adults aged 40-60 years. Menière's disease is at first progressive but fluctuating, and episodes can occur in clusters. Vertigo usually resolves but hearing deteriorates, and symptoms other than hearing loss and tinnitus usually improve regardless of treatment. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments for acute attacks of Menière's disease; and of interventions to prevent attacks and delay disease progression of Menière's disease? We searched: Medline, Embase, The Cochrane Library and other important databases up to January 2006 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found 17 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review we present information relating to the effectiveness and safety of the following interventions: anticholinergics, benzodiazepines, betahistine, cinnarizine, dietary modification, diuretics, phenothiazines, psychological support, trimetazidine, vestibular rehabilitation.

Effects of middle ear application of Cipro HC Otic Suspension in an animal model.

The objective of this study was to examine whether ciprofloxacin-containing otic drops (Cipro HC Otic Suspension; 0.2% ciprofloxacin, 0.1% hydrocortisone; Alcon, Ontario, Canada) are cochleotoxic in the chinchilla animal model. Five chinchillas in total underwent these studies. Pretreatment distortion-product otoacoustic emissions (DPOAEs) were measured in each ear, followed by a random injection of Cipro to one ear and normal saline to the other. Injections consisted of 0.2 mL into the middle ear cavity (bulla) for 5 consecutive days. Post-treatment DPOAEs and auditory brainstem responses were measured at 1 month, and cochlear hair cell integrity was assessed by scanning electron microscopy (SEM). All animals had normal pretreatment DPOAEs. One month after Cipro instillation, DPOAE levels decreased in three of the animals. No significant change was seen in the ears treated with saline. On SEM examination, the integrity of the stereocilia of the inner and outer hair cells demonstrated no histologic evidence of significant cochlear damage. The finding of reduced DPOAEs suggests a mild local middle ear inflammation caused by the ciprofloxacin or some other component or property of Cipro.