Management of drop attacks in Ménière's disease: a systematic literature review

Abstract

Objectives: Drop attacks are described as an instantaneous fall to the ground, occurring without warning and without loss of consciousness, a consequence of abrupt deformation of the otolithic membrane due to high endolymphatic pressure. Drop attacks present significant injury risk, therefore effective treatment is imperative. This review is the first to examine all evidence for the management of drop attacks in Ménière's disease, and make recommendations.

Methods: We conducted a systematic literature review. Inclusion criteria consisted of all published English language examining treatments of drop attacks in Ménière's disease.

Results: One hundred and five articles were identified, 19 met criteria (case series and/or cohort studies). Two articles identified conservative treatments, eight examined intratympanic gentamicin, seven examined surgery, one examined all three and one examined intratympanic dexamethasone.

Conclusion: Evidence for the management of drop attacks in Ménière's disease is limited due to small studies. Some surgical approaches have limited effect. Intratympanic dexamethasone remains a promising treatment; further research is recommended.

Keywords: Meniere disease; drop attack; endolymphatic hydrops; syncopal vertigo.