Positive pressure device treatment for Menière’s disease: an overview of the current evidence and a meta-analysis
- 70 Downloads
The objective was to critically assess the current evidence investigating the efficacy of using a positive pressure device in patients with definite or probable Menière’s disease.
We performed a systematic literature search in MEDLINE, EMBASE and PsycINFO up to February 2018. We included both systematic reviews and primary literature [randomized controlled trials (RCTs)] investigating positive pressure treatment, in patients (≥ 18 years of age), with Menière’s disease. We assessed the internal validity of systematic reviews using the AMSTAR tool and risk of bias of primary studies using the Cochrane Risk of bias tool. We performed a meta-analysis for each outcome based on the identified studies. The overall certainty of evidence for the outcomes was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE).
The search for systematic reviews identified four relevant reviews. These all included the same four RCTs. An updated search identified one additional RCT. In total, five RCTs were included in the data synthesis. Our data synthesis showed no effect of positive pressure treatment on primary nor secondary outcomes. No serious adverse events were reported. The overall certainty of evidence ranged from very low to low, due to the serious risk of bias and imprecision.
The current available evidence does not support positive pressure device treatment in patients with Menière’s disease. However, the limitations of the current literature hinder the possibility of any solid conclusion. There remains a need for randomized controlled trials of high quality to fully access the utility of this treatment.
KeywordsLow-pressure device Meniere’s disease Meniett device Positive pressure therapy Vertigo
The authors would like to thank information specialist Birgitte Holm Pedersen for assistance with the literature search.
The study was initiated and financed by the Danish Health Authority.
Compliance with ethical standards
Conflict of interest
The Authors declare no financial conflict of interests.
This article does not contain any studies with human participants or animals performed by any of the authors.
- 9.DanishHealthAuthority. National klinisk retningslinje for behandling af Menières (2018) October 9, 2018]; Available from: https://www.sst.dk/da/udgivelser/2018/nkr-behandling-af-menieres
- 10.Lopez-Escamez JA et al (2015) Diagnostic criteria for Meniere’s disease. J Vestib Res 25(1):1–7Google Scholar
- 11.Committee on Hearing and Equilibrium guidelines for the diagnosis and evaluation of therapy in Meniere’s disease. American Academy of Otolaryngology-Head and Neck Foundation, Inc. Otolaryngol Head Neck Surg, 1995. 113(3): 181–5Google Scholar
- 14.Covidence (Online software). 21.06.2018]; Available from: https://www.covidence.org/home
- 17.Mantel N, Haenszel W (1959) Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst 22(4):719–748Google Scholar
- 18.Review Manager (RevMan) (Computer program). 2014Google Scholar
- 19.MAGICapp (Online software). 21.06.2018]; Available from: https://app.magicapp.org/app -/guidelines
- 20.van Sonsbeek S, Pullens B, van Benthem PP (2015) Positive pressure therapy for Meniere’s disease or syndrome. Cochrane Database Syst Rev 2015(3):Cd008419Google Scholar