Effect of Dexamethasone Combination with Gentamicin in Chemical Labyrinthectomy on Hearing Preservation and Vertigo Control in Patients with Unilateral Meniere's Disease: A Randomized Controlled Clinical Trial.

Seong-Hoon Bae,Sung-Huhn Kim,Gina Na,Jeon-Mi Lee,Hyun-Jin Lee

doi:10.3390/jcm10235581

Abstract

Chemical labyrinthectomy using gentamicin is a popular method for treating intractable vertigo attacks in Meniere’s disease. However, the risk of hearing loss remains a major concern for clinicians. We investigated the effect of simultaneous dexamethasone and gentamicin application on hearing preservation and vertigo control in patients with intractable unilateral Meniere’s disease. A single-institutional, prospective, single-blinded, randomized clinical trial was conducted. Gentamicin-soaked Gelfoam® was directly applied on the oval window following middle ear exploration. On the round window, dexamethasone-soaked Gelfoam® was applied in the gentamicin with dexamethasone group (GD group, n = 18), and saline-soaked Gelfoam® was applied in the gentamicin with sham reagent group (GO group, n = 19). The hearing change 8 weeks after the procedure and vertigo control 2–12 months after the procedure were investigated. The high-frequency hearing threshold was significantly increased in the GO group (p = 0.005 and 0.012 for 4 and 8 kHz, respectively), but not in the GD group. The short-term (2–6 months) vertigo control was more successful in the GD group (57.89% vs. 94.44%, p = 0.019), but long-term control (6–12 months) was insignificant. In conclusion, the combined application of gentamicin and dexamethasone in chemical labyrinthectomy is an effective method for protecting high-frequency hearing and vertigo control.

Highlights

Meniere’s disease (MD) is an inner ear disorder characterized by episodic vertigo, fluctuating sensorineural hearing loss combined with aural fullness, and/or tinnitus [1]
0.019 * 0.079 a Absence of vertigo during the period. b Less than 40% of the frequency of vertigo compared to baseline during the period. * p < 0.05. In this prospective single-blinded randomized trial, chemical labyrinthectomy using gentamicin combined with dexamethasone showed a protective effect on high-frequency hearing level compared to the conventional method that uses gentamicin with normal saline
The combination method could more efficiently control the frequency of vertigo attacks until six months after the procedure

Summary

Introduction

Meniere’s disease (MD) is an inner ear disorder characterized by episodic vertigo, fluctuating sensorineural hearing loss combined with aural fullness, and/or tinnitus [1]. There are several invasive treatment options for these patients, such as endolymphatic sac surgery, chemical labyrinthectomy (intratympanic gentamicin (ITG) injection), labyrinthectomy, and vestibular neurectomy, based on the patients’ residual hearing level. Gentamicin via intratympanic injection or direct middle ear application is the most frequently used treatment because previous studies have shown better treatment outcomes with minimal morbidity [5]. This procedure is convenient and has minimal morbidity, the risk of hearing loss from chemical labyrinthectomy using gentamicin remains a major concern for clinicians because gentamicin is toxic to vestibular hair cells and to cochlear hair cells [6]. The short-term repeated gentamicin application showed a cumulative effect increasing the chance of hearing loss [10,11]

Methods

Results

Conclusion