Comparing Intratympanic to Surgical Management in Refractory Meniere Disease: A Systematic Review Plus Network Meta-analysis

Objective: We aimed to compare the efficacy of intratympanic and surgical interventions in the management of patients with refractory Meniere disease (MD). Databases reviewed: Embase, PubMed, Web of Science, Medline, Scopus, Google Scholar, and Cochrane Central Register of Control Trials up to April 2025. Materials and methods: The PRISMA guideline and PICO statement were used. The hearing preservation and vertigo control rate were compared between intratympanic gentamicin (ITGI), intratympanic corticosteroids (ITSI), vestibular nerve section (VNS), and endolymphatic sac surgery (ELSS). Classification of vertigo control rate was based on the AAO-HNS (1995) guideline, and the hearing outcome was assessed by the differences in the mean SDS percentage and PTA threshold before and after interventions. Results: In total, 16 studies including 853 participants met the inclusion criteria. VNS had significantly better outcomes of PTA and SDS than ITGI (change of PTA = MD: −16.9 dB, P -value: 0.002; change of SDS = MD: 15.64%, P -value: 0.001). As for comparisons of ELSS or ITSI with ITGI, no significant differences were found ( P > 0.05). VNS had numerically higher, but not statistically significant, vertigo control rate than ITGI (RR: 1.39, P -value: 0.57). ITGI demonstrated higher control rate than ELSS and ITSI, while only the difference between ITGI and ITSI was statistically significant (RR: 2.7, P -value: 001). Conclusions: VNS is the most effective option, which can be considered for patients who fail other treatments. ITGI was more effective than ELSS and ITSI in vertigo control, but it should be applied at low doses due to its ototoxic side effects.