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

TY - JOUR

T1 - Positive pressure device treatment for Menière's disease

T2 - an overview of the current evidence and a meta-analysis

AU - Devantier, Louise

AU - Guldfred, Frank Liviu-Adelin

AU - Djurhuus, Bjarki Ditlev

AU - Händel, Mina Nicole

AU - Schmidt, Jesper Hvass

AU - Hougaard, Dan Dupont

AU - Edemann-Callesen, Henriette

PY - 2019/5/1

Y1 - 2019/5/1

N2 - 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.

AB - 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.

KW - Bias

KW - Humans

KW - Meniere Disease/therapy

KW - Pressure

KW - Systematic Reviews as Topic

U2 - 10.1007/s00405-019-05359-y

DO - 10.1007/s00405-019-05359-y

M3 - Review

C2 - 30809697

SN - 0942-8992

VL - 276

SP - 1263

EP - 1273

JO - Archiv fur klinische und experimentelle Ohren- Nasen- und Kehlkopfheilkunde

JF - Archiv fur klinische und experimentelle Ohren- Nasen- und Kehlkopfheilkunde

IS - 5

ER -