Abstract
Objectives: A number of causes have been suggested for the etiology of Meniere's disease (MD), including herpes simplex virus infection, small endolymphatic sac size, vascular insufficiency, and fibrosis of the endolymphatic sac. Previous studies have demonstrated that 75% of the endolymphatic sacs from MD patients are HSV-1-positive relative to 7% of sacs from non-MD individuals. These statistically significant results suggest a possible role for HSV-1 in the etiology of MD and the development of endolymphatic hydrops. We hypothesize that the treatment of MD patients with an antiherpetic drug, famvir, will result in a reduction in the severity and frequency of MD.
Methods: Subjects with active MD symptoms were randomly assigned to either placebo or famvir for 3 months. Subjects (n = 24) were evaluated on number of dizzy spells, ENG, and hearing. Thirteen subjects received famvir, and the rest received placebo. There were 18 females. The average age at enrollment was 48, and the average amount of time since diagnosis was approximately 2 years.
Results: Interim analyses indicated that there were no differences in dizziness handicap or hearing from baseline to 3 months between the placebo and famvir groups. However, not all subjects have completed the protocol to date.
Conclusions: Interim analyses would seem to indicate that famvir was not effective in reducing dizzy spells or slowing Meniere's-associated hearing loss. Studies of the pharmacokinetics of anti-herpetic drugs would suggest that treatment of Meniere's patients during the initial episodes of the disease may be a more effective timeframe for treatment success.