{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T18:25:44Z","timestamp":1792520744165,"version":"4.5.0"},"reference-count":52,"publisher":"BMJ","issue":"4","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ EBM"],"accepted":{"date-parts":[[2021,10,13]]},"published-print":{"date-parts":[[2022,8]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To systematically review the efficacy of interventions for Meni\u00e8re\u2019s disease (MD) to report clinical implications of the results and to identify areas for future valuable research.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Abstracts (PRISMA-A) guideline, a systematic online database search was conducted in which MEDLINE (PubMed), Embase (Ovid) and CENTRAL (Cochrane Library) were searched until May 2021 in order to search for the efficacy of treatment was analysed in a systematic review. Systematic reviews (SRs) on treatments for MD were screened for eligible interventions. From these SRs, we included placebo randomised controlled trials (RCTs). A separate search was conducted to identify RCTs on treatment modalities that were systematically reviewed yet published after the conduction of these SRs. The primary outcome was control of vertigo as defined by the American guideline as published in 1995. The PRISMA-A and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to appraise and evaluate the certainty of evidence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We found five SRs from which 19 RCTs were extracted. Five RCTs were added by the separate search resulting in a total of 25 RCTs (n=1248) which evaluated the efficacy of betahistine dihydrochloride, intratympanic injections with gentamicin or steroids, endolymphatic sac surgery and pressure pulse therapy. Evidence on the efficacy of interventions for patients with MD is generally of low certainty. Betahistine (48\u2009mg per day and 144\u2009mg per day) and positive pressure therapy probably do not reduce MD symptoms when compared with placebo. Intratympanic injection with gentamicin or steroids, or treatment with endolymphatic surgery may reduce symptoms in MD when compared with placebo.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A definite effective and well-tolerated therapy for MD has yet to be discovered and information on the natural course of disease is one of the biggest flaws in current research.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PROSPERO registration number<\/jats:title>\n                    <jats:p>CRD4201502424.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjebm-2020-111410","type":"journal-article","created":{"date-parts":[[2021,11,8]],"date-time":"2021-11-08T13:20:14Z","timestamp":1636377614000},"page":"235-245","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":24,"title":["Interventions for Meni\u00e8re\u2019s disease: an umbrella systematic review"],"prefix":"10.1136","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0419-5760","authenticated-orcid":false,"given":"Babette Fiebke","family":"van Esch","sequence":"first","affiliation":[{"name":"Apeldoorn Dizziness Centre, Gelre Ziekenhuizen, Apeldoorn, The Netherlands"},{"name":"Otorhinolaryngology, Leids Universitair Medisch Centrum, Leiden, Zuid-Holland, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hester","family":"van der Zaag-Loonen","sequence":"additional","affiliation":[{"name":"Apeldoorn Dizziness Centre, Gelre Ziekenhuizen, Apeldoorn, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tjasse","family":"Bruintjes","sequence":"additional","affiliation":[{"name":"Apeldoorn Dizziness Centre, Gelre Ziekenhuizen, Apeldoorn, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ton","family":"Kuijpers","sequence":"additional","affiliation":[{"name":"Guideline Development and Research, Dutch College of General Practitioners, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter Paul G","family":"van Benthem","sequence":"additional","affiliation":[{"name":"Otorhinolaryngology - Head and Neck Surgery, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,11,8]]},"reference":[{"key":"2026071707551123000_27.4.235.1","first-page":"597","article-title":"Memoire sur les lesions de l\u2019orellei interne dinnant lieu des sympt\u00f4mes de congestion cerebrale apolectiforme","volume":"16","author":"Meni\u00e8re","year":"1861","journal-title":"Gazette Medical de Paris"},{"key":"2026071707551123000_27.4.235.2","doi-asserted-by":"publisher","DOI":"10.1097\/00019052-200402000-00004"},{"key":"2026071707551123000_27.4.235.3","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-009-0109-x"},{"key":"2026071707551123000_27.4.235.4","doi-asserted-by":"publisher","DOI":"10.1097\/01.psy.0000232269.17906.92"},{"key":"2026071707551123000_27.4.235.5","doi-asserted-by":"crossref","unstructured":"Sajjadi H , Paparella MM . 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