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

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  • Louise Devantier
  • Frank Liviu-Adelin Guldfred
  • Bjarki Ditlev Djurhuus
  • Mina Nicole Händel
  • Jesper Hvass Schmidt
  • Dan Dupont Hougaard
  • Henriette Edemann-Callesen
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OBJECTIVE: 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.

METHODS: 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).

RESULTS: 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.

CONCLUSION: 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.

Original languageEnglish
JournalEuropean archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery
Volume276
Issue number5
Pages (from-to)1263-1273
Number of pages11
ISSN0003-9195
DOIs
Publication statusPublished - May 2019

    Research areas

  • Bias, Humans, Meniere Disease/therapy, Pressure, Systematic Reviews as Topic

ID: 58098813