Is dexamethasone (corticosteroid) effective for treating vertigo?

Dexamethasone for Vertigo Management

Intratympanic dexamethasone is effective for treating vertigo in Ménière's disease with success rates of 70-90% for vertigo control, though it is generally recommended after failure of first-line noninvasive treatments. 1

Efficacy of Dexamethasone in Vertigo

Dexamethasone has shown effectiveness primarily in treating vertigo associated with Ménière's disease through intratympanic (IT) administration. The American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) guidelines provide evidence for its use:

• IT steroid therapy has demonstrated improvement in vertigo symptoms (85-90%) compared to placebo or conventional therapy (57-80%) 1
• Complete vertigo control rates range from 31-90% with IT steroid therapy 1
• Efficacy increases when combined with betahistine (73% control vs 44% without) 1

Administration Protocol for Vertigo Control

For patients with Ménière's disease not responsive to noninvasive treatments:

Intratympanic Administration:

• Dosage:
  • Dexamethasone sodium phosphate 4-10 mg/mL (stock) or 16-24 mg/mL (compounded) 1
  • Inject 0.4-0.8 mL into middle ear space 1

Treatment Schedule:

• Initial treatment: 1-4 sessions every 3-7 days depending on clinical response 1
• Duration: May require repeated courses for sustained benefit 2
• Timing: Most effective when initiated within first 2 weeks of symptoms 1

Comparative Efficacy and Safety Profile

Efficacy Comparison:

• IT dexamethasone shows lower complete vertigo control (31-90%) compared to IT gentamicin (70-87%) 1
• However, studies show sustained control in 70% of patients at 2 years with dexamethasone 3

Safety Profile:

• Major advantage: Lower risk of hearing loss (0-8%) compared to gentamicin (12.5-15.4%) 1
• Complications are minimal:
  • Rare hearing deterioration (reported in 8% of cases) 1, 4
  • Occasional tympanic membrane perforation 5

Treatment Algorithm for Vertigo

1. First-line: Noninvasive treatments (low-salt diet, diuretics) 6, 5
2. If vertigo persists after 6 months:
   • Begin IT dexamethasone injections 7
3. If no improvement after 3 months of IT dexamethasone:
   • For patients with profound hearing loss: Consider IT gentamicin 7
   • For patients with good hearing: Consider endolymphatic sac decompression 7
4. For recurrent vertigo after initial control:
   • Repeat IT dexamethasone injections (60% success rate for retreatment) 5

Additional Benefits Beyond Vertigo Control

IT dexamethasone also improves other Ménière's disease symptoms:

• Tinnitus improvement: 48% (vs 20% with placebo) 4
• Aural fullness improvement: 48% (vs 20% with placebo) 4
• Hearing loss improvement: 35% (vs 10% with placebo) 4

Important Clinical Considerations

• Long-term efficacy: Single courses provide control in only 24% of patients at 2 years; multiple courses may be needed for sustained benefit 2
• Timing matters: Early intervention (within first 2 weeks) may increase recovery rates 1
• Patient selection: Best candidates are those with intractable vertigo who have failed conservative management 5, 3
• Monitoring: Audiometric testing before and after treatment to monitor hearing function 1, 6

Pitfalls and Caveats

• Avoid relying on a single course of treatment; be prepared for potential need for repeated injections 2
• Do not use as first-line therapy before attempting noninvasive treatments 1, 7
• Be cautious in patients with bilateral disease as treatment may affect hearing 1
• Consider that efficacy decreases over time, with control rates dropping from 92% at 6 months to 70% at 2 years 3

Intratympanic dexamethasone represents an effective, minimally invasive option for vertigo control in Ménière's disease with a favorable safety profile compared to more destructive alternatives.