European Archives of Oto-Rhino-Laryngology

, Volume 276, Issue 5, pp 1263–1273 | Cite as

Positive pressure device treatment for Menière’s disease: an overview of the current evidence and a meta-analysis

  • Louise DevantierEmail author
  • Frank Liviu-Adelin Guldfred
  • Bjarki Ditlev Djurhuus
  • Mina Nicole Händel
  • Jesper Hvass Schmidt
  • Dan Dupont Hougaard
  • Henriette Edemann-Callesen
Review Article



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.


Low-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.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Supplementary material

405_2019_5359_MOESM1_ESM.pdf (1.9 mb)
Supplementary material 1 (PDF 1928 KB)


  1. 1.
    Covelli E et al (2017) Delayed effect of active pressure treatment on endolymphatic hydrops. Audiol Neurootol 22(1):24–29CrossRefGoogle Scholar
  2. 2.
    Magnan J et al (2018) European position statement on diagnosis, and treatment of Meniere’s disease. J Int Adv Otol 14(2):317–321CrossRefGoogle Scholar
  3. 3.
    Nevoux J et al (2018) International consensus (ICON) on treatment of Meniere’s disease. Eur Ann Otorhinolaryngol Head Neck Dis 135(1 s):S29–Ss32CrossRefGoogle Scholar
  4. 4.
    Tjernstrom O (1977) Effects of middle ear pressure on the inner ear. Acta Otolaryngol 83(1–2):11–15CrossRefGoogle Scholar
  5. 5.
    Thomsen J et al (2005) Local overpressure treatment reduces vestibular symptoms in patients with Meniere’s disease: a clinical, randomized, multicenter, double-blind, placebo-controlled study. Otol Neurotol 26(1):68–73CrossRefGoogle Scholar
  6. 6.
    Guyatt GH et al (2011) GRADE guidelines: a new series of articles. J Clin Epidemiol 64(4):380–382CrossRefGoogle Scholar
  7. 7.
    Moher D et al (2015) Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 4:1CrossRefGoogle Scholar
  8. 8.
    Guyatt GH et al (2011) GRADE guidelines: 2. Framing the question and deciding on important outcomes. J Clin Epidemiol 64(4):395–400CrossRefGoogle Scholar
  9. 9.
    DanishHealthAuthority. National klinisk retningslinje for behandling af Menières (2018) October 9, 2018]; Available from:
  10. 10.
    Lopez-Escamez JA et al (2015) Diagnostic criteria for Meniere’s disease. J Vestib Res 25(1):1–7Google Scholar
  11. 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
  12. 12.
    Shea BJ et al (2007) Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol 7:10CrossRefGoogle Scholar
  13. 13.
    Higgins JP et al (2011) The cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 343:d5928CrossRefGoogle Scholar
  14. 14.
    Covidence (Online software). 21.06.2018]; Available from:
  15. 15.
    Higgins JP, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21(11):1539–1558CrossRefGoogle Scholar
  16. 16.
    DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7(3):177–188CrossRefGoogle Scholar
  17. 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. 18.
    Review Manager (RevMan) (Computer program). 2014Google Scholar
  19. 19.
    MAGICapp (Online software). 21.06.2018]; Available from: -/guidelines
  20. 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
  21. 21.
    Ahsan SF, Standring R, Wang Y (2015) Systematic review and meta-analysis of Meniett therapy for Meniere’s disease. Laryngoscope 125(1):203–208CrossRefGoogle Scholar
  22. 22.
    Zhang SL et al (2016) Meniett therapy for Meniere’s disease: an updated meta-analysis. Otol Neurotol 37(3):290–298CrossRefGoogle Scholar
  23. 23.
    Syed MI et al (2015) Positive pressure therapy for Meniere’s syndrome/disease with a Meniett device: a systematic review of randomised controlled trials. Clin Otolaryngol 40(3):197–207CrossRefGoogle Scholar
  24. 24.
    Russo FY et al (2017) Meniett device in meniere disease: Randomized, double-blind, placebo-controlled multicenter trial. Laryngoscope 127(2):470–475CrossRefGoogle Scholar
  25. 25.
    Gurkov R et al (2012) Effect of transtympanic low-pressure therapy in patients with unilateral Meniere’s disease unresponsive to betahistine: a randomised, placebo-controlled, double-blinded, clinical trial. J Laryngol Otol 126(4):356–362CrossRefGoogle Scholar
  26. 26.
    Gates GA et al (2004) The effects of transtympanic micropressure treatment in people with unilateral Meniere’s disease. Arch Otolaryngol Head Neck Surg 130(6):718–725CrossRefGoogle Scholar
  27. 27.
    Odkvist LM et al (2000) Effects of middle ear pressure changes on clinical symptoms in patients with Meniere’s disease—a clinical multicentre placebo-controlled study. Acta Otolaryngol Suppl 543:99–101CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Louise Devantier
    • 1
    • 2
    Email author
  • Frank Liviu-Adelin Guldfred
    • 3
  • Bjarki Ditlev Djurhuus
    • 4
  • Mina Nicole Händel
    • 5
    • 6
  • Jesper Hvass Schmidt
    • 7
    • 8
  • Dan Dupont Hougaard
    • 9
  • Henriette Edemann-Callesen
    • 5
  1. 1.Department of Clinical MedicineAarhus UniversityAarhus CDenmark
  2. 2.Department of Oto-Rhino-LaryngologyRegional Hospital West JutlandHolstebroDenmark
  3. 3.Ear, Nose and Throat ClinicFaxeDenmark
  4. 4.Department of Ear, Nose, Throat and Maxillofacial SurgeryZealand University HospitalKoegeDenmark
  5. 5.The Danish Health AuthorityCopenhagenDenmark
  6. 6.The Parker InstituteCopenhagen University Hospital, Bispebjerg and FrederiksbergFrederiksbergDenmark
  7. 7.Department of ORL, Head and Neck Surgery and AudiologyOdense University HospitalOdense CDenmark
  8. 8.Department of Clinical Research, Faculty of Health SciencesUniversity of Southern DenmarkOdenseDenmark
  9. 9.Department of Otolaryngology, Head & Neck Surgery and AudiologyAalborg University HospitalAalborgDenmark

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