Frequency Of Vertigo Research Articles

Intratympanic steroids for Ménière's disease or syndrome

Ménière's disease is a disorder characterised by hearing loss, tinnitus and disabling vertigo.The use of intratympanic steroids to reduce the severity of these symptoms has been gaining popularity. To assess the effectiveness of intratympanic steroids on the frequency and severity of attacks of vertigo, on chronic symptoms such as tinnitus, imbalance and hearing loss, and on the progression of these symptoms in patients with definite Ménière's disease or syndrome, as defined by the AAO-HNS Committee. We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. The date of the most recent search was 13 January 2011. Randomised controlled trials of intratympanic dexamethasone versus placebo in patients with Ménière's disease. Two authors independently assessed trial risk of bias and extracted data. We contacted study authors for further information where possible. A single trial containing 22 patients, with a low risk of bias was included.This trial found that after 24 months, compared with placebo, the use of intratympanic dexamethasone demonstrated a statistically significant improvement in vertigo as defined by a respective improvement in functional level (90% versus 42%), class (82% versus 57%), change in Dizziness Handicap Inventory scores (60.4 versus 41.3) and mean vertigo subjective improvement (90% versus 57%).The treatment regime described by the authors involved daily injections of dexamethasone solution 4 mg/ml for five consecutive days. These results were clinically significant. No complications were reported. The results of a single trial provide limited evidence to support the effectiveness of intratympanic steroids in patients with Ménière's disease. This trial demonstrated a statistically and clinically significant improvement of the frequency and severity of vertigo measured 24 months after the treatment was administered. It is important to note that there were a few aspects of the study which we were unable to clarify with the study authors.

Application of autogenic training in patients with Ménière disease

Data are limited on the role of psychotherapy in the treatment of Ménière disease. We sought to document the effect of a psychotherapeutic technique known as autogenic training on clinical outcome in Ménière disease. Six patients with Ménière disease were studied. Retrospective chart review was conducted. All patients were refractory to conventional therapy and completed a course of autogenic training, which was offered as a complementary treatment. Autogenic training with initial psychological counseling was conducted by a clinical psychologist during 45-min sessions. Outcome measures assessed were the frequency of vertigo and functional levels 2years after initiation of autogenic training. Functional levels were evaluated according to the 1995 guidelines of the American Academy of Otolaryngology-Head Neck Surgery (AAO-HNS). As a personality measure, we used the Maudsley Personality Inventory (MPI), devised by Eysenck, which measures neuroticism (N), extraversion (E), and propensity to lie (L). Five of six patients showed improved functional level after three to eight sessions of psychotherapy; hearing level did not change. The score of the N scale of the MPI was closely related to the number of psychotherapy sessions. Prognosis was evaluated based on the AAO-HNS reporting guidelines, as follows: A=3, B=1, C=1, F=1. The value of N in MPI was closely related to the number of psychological counseling sessions (R=0.97, P<0.05). In conclusion, autogenic training may enhance the mental well-being of patients with Ménière disease and improve clinical outcome.

A Clinical Epidemiological Study in 187 Patients with Vertigo

A retrospective study to investigate the clinical epidemiological characteristics of vertigo was carried out on 187 patients with vertigo. A clinical history for each patient was recorded precisely about the attack, frequency, and development of vertigo, its duration, intensity, and the accompanied symptoms including the risk factors for cerebrovascular disease, etc. All the patients were subjected to physical examination with special attention to neurologic systems and Dix-Hallpike maneuver, computed tomography/computed tomography-angiography (CT/CTA) and MRI scan were performed when necessary. Majority of the patients in this study suffered with posterior circulation ischemia (59.89%) and benign paroxysmal positional vertigo (16.04%). Other ailments that affected these patients included migraine, Meniere's disease (1.6%), sudden hearing loss (1.07%), vestibular neuronitis, multiple sclerosis, acute viral encephalitis, meningioma, neurosis, posttraumatic vertigo, acute myocardial infarction (0.53%), and neurosis (14.97%). It appeared that in comparison to younger patients the elderly population is likely to be more susceptible to vertigo. Vertigo attacks patients with various diseases, which pre-dispose the patients to this disease. Presentation of vertigo can be clinically diagnosed in most cases of patients suffering from posterior circulation ischemia.

Lateral Semicircular Canal Plugging in Severe Ménière's Disease

To evaluate the safety and efficiency of the plugging of the lateral semicircular canal to control vertigo in severe Ménière's disease (MD). Prospective follow-up study. University hospital. Twenty-eight patients with MD with refractory vertigo and severe disability (functional scale 5 or 6). Lateral canal plugging was performed in pathological ear for each patient. The evaluation of therapy followed the guidelines for diagnosis and evaluation of therapy in MD (1995). Hearing, frequency of vertigo, and functional disability were assessed in the early follow-up (6 mo) for all the patients and in the late follow-up (2 yr) for 16 patients. In addition, the canal paresis was evaluated by caloric test. No vital complication occurred. The hearing was preserved in 82% of cases. Lateral canal plugging induced in all cases a canal paresis that was persistent after 2 years. After 2 years (n = 16), the control of vertigo was complete or substantial in 75% of cases (A1, restoration of a normal life: 62.5%; B2, no functional restriction: 12.5%). Lateral canal plugging is a safe procedure that induces a canal paresis and allows a good control of vertigo. In view of these results, the lateral canal plugging should be a therapeutic option for controlling rotatory vertigo in severe MD.

Vestibular Function and Vertigo Control after Intratympanic Gentamicin for Ménière’s Disease

The aim of this study was to correlate long-term vertigo control with reduction in vestibular function after intratympanic (IT) gentamicin therapy for unilateral Ménière’s disease. IT gentamicin injections were given as needed to control vertigo attacks. Vertigo frequency and changes in angular vestibulo-ocular reflex (AVOR) gain (measured using magnetic search coils and manual head thrusts) and caloric weakness were assessed before and after treatment. Better vertigo control after treatment was found with ≥60% reduction in quantitative ipsilateral horizontal semicircular canal AVOR gain from pre-treatment values and/or with caloric unilateral weakness (UW) >50%. However, no correlations were found between the continuous variables of vertigo control and either gain or gain recovery, nor between gain and UW because of the large variability in vertigo control in subjects with lesser reductions in these measures.

“Vestibular migraine”: effects of prophylactic therapy with various drugs

Vertigo is frequently associated with migraine, and sometimes it is the cardinal symptom. This type of migraine is called "vestibular migraine", "migrainous vertigo", or "migraine-associated vertigo". Earlier findings on effective prophylactic medication for such migraine attacks and their clinical features are few and insufficient. Our aim was to study the influence of prophylactic therapy on this type of migraine and to specify its clinical features. In a retrospective approach 100 patients (median age 47 years, range 21-72 years) with definite or probable vestibular migraine were divided into two groups: those with (74 patients) and those without drug prophylaxis (26 patients). They were then interviewed by telephone at least 6 months after beginning therapy. All patients receiving medical prophylaxis showed a decrease of duration, intensity, and frequency of episodic vertigo as well as nearly all its associated features (p < 0.01). The group without medical prophylactic therapy showed only a reduction of vertigo intensity. Only 39 % of the 100 patients met the current IHS criteria for a basilar-type migraine. Thus, we propose that a new category--"vestibular migraine"--should be added to the HIS criteria. Furthermore, our data show that prophylactic medication may be effective for treating vestibular migraine and its associated symptoms; therefore, patient's response to medical therapy may provide guidance in the diagnostic process of vestibular migraine.

Treatment of Meniere's Disease with Low-Concentration Intratympanic Gentamicin Injection

Background and Objectives：Intratympanic gentamicin injection is used as one of the treatment modalities for medically intractable Meniere’s disease. But the ideal dosage and concentration of gentamicin were not established in consideration of therapeutic efficacy and the risk of postoperative hearing loss. We analyzed the clinical outcome of low-concentration intratympanic gentamicin injection in patients with Meniere’s disease. And we also tried to find factors anticipating for the response to treatment. Subjects and Method：A retrospective review was conducted on 45 subjects who had been diagnosed as ‘definite’ Meniere’s disease (AAO-HNS, 1995) and had no response to medical treatment over 3 months in our clinic. The concentration of gentamicin was 7 mg/cc, which was very low compared with previous studies. We reviewed postoperative changes on vertigo, tinnitus and hearing by questionnaire and pure tone audiometry. We also analyzed preoperative patients’ characteristics for acquisition of predictive factors of treatment response. Results：Vertigo was completely disappeared in 37 (82%) patients and there was no vertigo improvement in 8 (18%) patients despite multiple injections. Tinnitus was controlled in 11 (24%) patients, and aggravated in 4 (8%) patients. A significant postoperative hearing loss over 10 dB occurred in only 6 (13%) patients. Preoperative patients’ hearing threshold, frequency of vertigo, functional level and finding in electrical test, such as electrocochleogram, were not different regarding treatment response. Conclusion：Low-concentration gentamicin was enough to control vertigo and could reduce the risk of postoperative hearing loss in patients with Meniere’s disease. (Korean J Otorhinolaryngol-Head Neck Surg 2009;52:322-6)

Treatment of Meniere's Disease and Intratympanic Gentamicin Injection

Background and Objectives Several treatment options have been introduced to control Meniere’s disease (MD). Among them, intratympanic injection of gentamicin (ITGM) is now accepted as a standard treatment method for intractable vertigo in patients with hearing impaired MD. The purpose of this study was to analyze the clinical course and treatment flow in patients with MD and to analyze the efficacy and problems after ITGM. Subjects and Method A retrospective study was performed on 458 patients who were diagnosed as definite MD from May 2003 to October 2007 and were followed up at least 1 year. The authors investigated the course of disease and the results in our patients according to the treatment options. Several clinical parameters including frequency of vertigo, audiometry, caloric and rotation test were reviewed and analyzed according to the guideline of the AAO-HNS (1995), if necessary. Efficacy and problems after ITGM were reviewed. Results Among 458 patients, vertigo was resolved or improved in 399 patients (87.1%) with medical management. Fifty-nine patients needed further treatment (endolymphatic sac decompression: 4, Meniette: 2, ITGM: 53). Among 53 patients who got ITGM, 40 patients were followed up for more than 1 year after injection. Thirty-six patients (87.5%) showed successful control of vertigo. The average pure-tone threshold was changed from 54.1 dB to 56.9 dB after treatment. Three patients (7.5%) revealed more than 20 dB aggravation. Conclusion Vertigo was controlled by supportive treatments or medication in 87% of definite MD patients. And ITGM could effectively and reasonably control vertigo for intractable MD patients.

THE DEVELOPMENT OF RING-SHAPED CONTRAST ENHANCEMENT IN A CASE OF CEREBELLAR DYSEMBRYOPLASTIC NEUROEPITHELIAL TUMOR

Dysembryoplastic neuroepithelial tumor (DNT) occurs rarely in the cerebellum. We describe a rare case of cerebellar DNT that developed contrast enhancement after long-term observation and discuss the underlying mechanism and clinical relevance of this unusual phenomenon. A 34-year-old woman with known cystic cerebellar lesions presented with increased frequency of vertigo and new onset of truncal ataxia. Magnetic resonance imaging revealed new contrast enhancement in the dominant cystic lesion of the cerebellar vermis without any change in size and shape or evidence of edema. The lesions were resected under magnetic resonance imaging guidance. Histological assessment revealed populations of small, round cells in a microcystic background containing "floating" neurons, diagnostic of DNT. Microvascular proliferation and pigmented neurons were also present. This is the first report of the development of contrast enhancement in a previously nonenhancing case of cerebellar DNT. The acquisition of ring-shaped contrast enhancement may be associated with microvascular proliferation, but otherwise no evidence of malignant progression. In addition, this case presents the novel pathological finding of pigmented neurons in DNT.

Evaluation of Quality of Life After Intratympanic Streptomycin Injection in Patients With Ménière's Disease

Quality of life (QOL) and satisfaction level of patients with Ménière's disease who underwent intratympanic streptomycin injection were evaluated across physical, psychological, and social domains of function. Preoperative and postoperative QOL of patients were evaluated based on the chart records of patients and questionnaire surveys. From January 2000 to August 2005, 81 patients underwent intratympanic streptomycin injection at Yonsei University Severance Hospital, and their medical records were retrospectively reviewed. In addition, a mailed questionnaire survey was conducted. Ménière's Disease Outcome Questionnaire-Retrospective Version, proposed by Kato et al., was used as the QOL measure and was completed by 51 patients. The average QOL score was 35.6 +/- 9.6 before surgery and 52.8 +/- 10.3 after surgery, indicating improvement of QOL by 17.2 after surgery. The improvement of QOL score did not correlate to age and sex of patients; nonetheless, higher improvement of score was found in patients with professional career (p < 0.001). The improvement of QOL in the preoperative Stage 3 and 4 patient groups was greater than that in the preoperative Stage 1 and 2 patient groups (p = 0.032). The mean change in hearing of the patients after surgery was 1.5 + 7.2 dB hearing loss based on a 4-frequency pure-tone average (500, 1,000, 2,000, 3,000 Hz). Furthermore, 4 (7.8%) of 51 patients demonstrated greater than 10-dB change in 4-frequency pure-tone average. The status of hearing loss after surgery did not influence the QOL score (p = 0.530). As the frequency of vertigo decreased, the improvement of QOL score increased (p = 0.042). The level of satisfaction with intratympanic streptomycin injection was strongly correlated to the QOL score in Ménière's Disease Outcome Questionnaire-Retrospective Version. As for the factors that improved the QOL after surgery, the status of hearing was not closely associated; however, the frequency of vertiginous symptom was the most important factor.

メニエール病に対するイソソルビド液状とゼリー状の治療効果と服薬コンプライアンスの比較検討

Most patients with Meniere's disease can be successfully treated with medication. In Japan, since the 1980's we have usually used osmotic diuretics, such as Isosorbide-liquid to control the inner ear endolymphatic hydrops. We have, however, had problems in that Meniere's patients sometimes complain of the tough regimen involving taking Isosorbide-liquid on a daily basis. Recently, Isosorbide-jelly has been developed to improve the medication compliance for patients with Meniere's disease. In the present study, we examined differences between the effects of Isosorbide-liquid and Isosorbide-jelly on hearing and vertigo. We also compared the medication compliance of Isosorbide-liquid with that of Isosorbide-jelly. There were no significant differences in hearing level and vertigo frequency in Meniere's patients before and after Isosorbide-liquid was changed to Isosorbide-jelly. Regarding medication compliance, we should consider which Isosorbide-type we use for each patient on an individual basis.

Persistent Dizziness After Surgical Treatment of Vertigo

Persistent vertigo and imbalance can occur after surgery for vertigo regardless of surgical approach. This study explored for factors affecting outcome of vertigo surgery. Patient survey and chart review. Tertiary referral neurotologic private practice. Of 111 patients (57.7% female; mean age, 52.3 yr), 59 underwent vestibular nerve section (middle fossa, retrolabyrinthine, and translabyrinthine), 25 underwent transmastoid labyrinthectomy, and 27 underwent endolymphatic sac shunt. Eighty-three percent had Ménière's disease. Mean follow-up was 4.3 years. Primary outcomes included American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) vertigo score and class, number of spells per month, current and change in AAO-HNS disability rating, vertigo and imbalance severity ratings, and frequency of imbalance. Three preoperative factors were consistently related to outcome: AAO-HNS disability rating, imbalance frequency rating, and duration of first symptom ([rho] = 0.19-0.51; all p's < 0.05). Greater disability and more frequent imbalance related to poorer outcome, but longer duration of disease related to better outcome. Presurgery vertigo characteristics were generally not related to outcome. Ménière's patients were more likely to have improvement in imbalance, as were those with no other significant disease and no allergy. The presence of tinnitus in the contralateral ear was associated with poorer outcomes, including a lower rate of results of Classes A and B (p = 0.023). Vertigo as a first symptom and the presence of eye disease also showed relationships to poorer outcome. Those rating themselves as more disabled before surgery are less likely to achieve the best outcomes, whereas frequency and severity of preoperative vertigo are not predictive. Several possible prognostic factors were identified that warrant future prospective study.

Meniett Clinical Trial: Long-term Follow-up

To delineate 2-year efficacy of Meniett device therapy in people with classic, unilateral, Ménière's disease unresponsive to traditional medical treatment. A 2-year long-term unblinded follow-up after a prior randomized, placebo-controlled, multicenter clinical trial of the Meniett device for Ménière's disease. Follow-up was performed remotely by using diaries and questionnaires mailed to the data coordinating center by the participants. Those who failed to mail their diaries were interviewed by telephone. Sixty-one study participants agreed to use the Meniett device and report their symptoms for 2 years. All had active, unilateral cochleovestibular disease. Outcomes are available for 58 participants; 2 were unavailable for follow-up and 1 was excluded because of a concurrent condition that precluded Meniett device use. Participants were advised to adhere to a low-sodium diet, use the Meniett device 3 times daily, and maintain a patent tympanostomy tube in the affected ear. Diuretic and vestibular suppressant medications were used as needed. Outcomes were based on the participants' daily diary, questionnaires, and telephone interviews. Three different analyses were prepared: tracking of vertigo frequency throughout the study, comparison of vertigo frequency before and at the end of Meniett device use (American Academy of Otolaryngology-Head and Neck Surgery Foundation reporting guideline), and Kaplan-Meier estimates of vertigo remission and recurrence. Vertigo levels gradually improved for most but not all participants. American Academy of Otolaryngology-Head and Neck Surgery Foundation class A (remission) or class B (greatly improved) results occurred in 67% (39/58) of participants, and class F (dropped out to receive surgical therapy) results occurred in 24%. Of the 44 nondropout participants, 39 (89%) had American Academy of Otolaryngology-Head and Neck Surgery Foundation group A or B outcomes. People who went into remission were highly likely (80%) to remain in remission long term; participants who achieved remission (20/43; 47%) did so within the first year of follow-up. Use of the Meniett device was associated with a significant reduction in vertigo frequency in about two thirds of the participants, and this improvement was maintained long term. Therapy with the Meniett device is a safe and effective option for people with substantial vertigo uncontrolled by medical therapy.

‘Complementary ENT’: a systematic review of commonly used supplements

To assess the evidence surrounding the use of certain complementary supplements in otolaryngology. We specifically focussed on four commonly used supplements: spirulina, Ginkgo biloba, Vertigoheel and nutritional supplements (cod liver oil, multivitamins and pineapple enzyme). A systematic review of the English and foreign language literature. in vivo human studies. animal trials, in vitro studies and case reports. We also excluded other forms of 'alternative medicine' such as reflexology, acupuncture and other homeopathic remedies. Lack of common outcome measures prevented a formal meta-analysis. Three studies on the effects of spirulina in allergy, rhinitis and immunomodulation were found. One was a double-blind, placebo, randomised, controlled trial (RCT) of patients with allergic rhinitis, demonstrating positive effects in patients fed spirulina for 12 weeks. The other two studies, although non-randomised, also reported a positive role for spirulina in mucosal immunity. Regarding the use of Ginkgo biloba in tinnitus, a Cochrane review published in 2004 showed no evidence for this. The one double-blind, placebo-controlled trial that followed confirmed this finding. Regarding the use of Vertigoheel in vertigo, two double-blind RCTs and a meta-analysis were identified. The first RCT suggested that Vertigoheel was equally effective in reducing the severity, duration and frequency of vertigo compared with betahistine. The second RCT suggested that Vertigoheel was a suitable alternative to G. biloba in the treatment of atherosclerosis-related vertigo. A meta-analysis of only four clinical trials confirms that Vertigoheel was equally effective compared with betahistine, G. biloba and dimenhydrinate. Regarding multivitamins and sinusitis, two small paediatric pilot studies reported a positive response for chronic sinusitis and otitis media following a course of multivitamins and cod liver oil. Regarding bromelain (pineapple enzyme) and sinusitis, one randomised, multicentre trial including 116 children compared bromelain monotherapy to bromelain with standard therapy and standard therapy alone, for the treatment of acute sinusitis. The bromelain monotherapy group showed a faster recovery compared with the other groups. The positive effects of spirulina in allergic rhinitis and of Vertigoheel in vertigo are based on good levels of evidence, but larger trials are required. There is overwhelming evidence that G. biloba may play no role in tinnitus. There is limited evidence for the use of multivitamins in sinus symptoms, and larger randomised trials are required.

Factors Relating to the Vertigo Control and Hearing Changes Following Intratympanic Gentamicin for Intractable Ménière's Disease

To look for factors relating to the vertigo control and hearing changes after intratympanic injections of gentamicin (GM). Prospective. Tertiary referral medical center. Twenty-eight patients with intractable Ménière's disease. Three intratympanic injections of GM (once per day for three consecutive days). Although five patients needed further GM injections or vestibular neurectomy because of poor control (Group I), 23 patients had their vertigo controlled for more than two years without further treatment (Group II). The number of vertigo spells per month, pure-tone audiometry, electrocochleography, caloric response, post-head shake nystagmus, and plasma vasopressin as a stress marker were examined. Before GM injections, there was no difference in the number of vertigo spells per month between Groups I and II. However, the hearing thresholds were higher in Group I. Hearing improvement, increase in percentage of canal paresis and induction of post-head shake nystagmus were observed after GM injections only in Group II. Even in the 11 patients who showed an improvement in hearing of more than 10 dB (hearing improvement group), percentage of canal paresis was increased after GM. More, premedication plasma vasopressin levels were lower in the hearing improvement group as compared with the hearing loss/no changes group. Four of eight patients became negative for dominant negative summating potential in electrocochleography after GM injections in the hearing improvement group. Our data indicate that the frequency of vertigo is not a key factor in the vertigo control after GM injections, that induction of vestibular damage in the injected ear is essential for the control of vertigo and this effect is mostly pronounced in patients with milder hearing loss, and that hearing improvement is not only a consequence of good vertigo control but also affected by the stress level before treatment.

Oral Administration of Prednisone to Control Refractory Vertigo in Ménière's Disease: A Pilot Study

To establish whether the oral administration of moderate doses of prednisone reduces refractory vertigo in Ménière's disease. Blinded, randomized, controlled trial. Tertiary referral center. Patients with Ménière's disease with limited vertigo control (Class C) and severe disability (Scale 3). Two groups (n = 8 per group) were treated orally with either diphenidol (25 mg/d) plus acetazolamide (250 mg/48 h) (control group), or the same treatment plus prednisone (0.35 mg/kg) daily for 18 weeks (prednisone group). The variables evaluated were the frequency and duration of vertigo, tinnitus, aural fullness, and audiographic parameters. The clinical surveillance was performed for 12 months after prednisone withdrawal. The frequency and duration of vertigo episodes were reduced by 50% and 30%, respectively, by prednisone treatment. Prednisone-treated patients manifested a significant reduction in tinnitus. No changes were observed in aural fullness or hearing. No metabolic or infectious disorders were observed. Oral prednisone helps to control refractory vertigo in Ménière's disease. These preliminary data suggest that prednisone can be a good noninvasive antivertigo management regimen for these patients.

Vertigo and balance problems in children—An epidemiologic study in Finland

There is only scant data about the frequency and characteristics of vertigo in children. The aim of the study was to determine the prevalence and characteristics of vertigo and balance problems in children aged between 1 and 15 years. One thousand and fifty children aged from 1 to 15 years from one child welfare unit and three schools in Helsinki University Hospital District received a questionnaire acquiring about their dizzy symptoms. Of 1050 eligible children, 938 (89%) or a caregiver completed a simple screening questionnaire, 8% had experienced vertigo and 23% of these it was so severe vertigo that it prevented their present activity. Reason for vertigo was unknown in one third of the children and 69% could name a provocative factor for their vertigo. Balance problems are not rare in children and can limit their daily activities.

Endolymphatic Sac Decompression as a Treatment for Meniere's Disease

Endolymphatic sac decompression is a surgical treatment option for patients with medically intractable Meniere's disease. However, effectiveness is debated because published data show great variability. Outcome-based research studies are useful in incorporating the patient's perspective on the success of treatment. To further assess effectiveness of endolymphatic sac decompression, we performed a prospective study to examine both symptom-specific and general health outcomes. Prospective, observational outcome study. Nineteen patients with endolymphatic sac decompression responded to symptom-specific questionnaires and the Medical Outcomes Short-Form 36 Health Survey (SF-36) before and after surgery. Follow-up ranged from 6 to 58 months with a mean duration of 50 months. Overall measures of physical health were significantly improved following endolymphatic sac decompression (P = .04), whereas overall measures of mental health were unchanged (P = .74). Role Physical and Social Functioning scores were significantly improved following endolymphatic sac decompression (P = .04 and P = .03, respectively). Study patients scored significantly lower (P < .05) than SF-36 normative data in 6 of 10 categories before endolymphatic sac decompression but patient scores were not significantly different from normal scores in all but one category (General Health) following endolymphatic sac decompression. The mean number of vertigo episodes was significantly reduced from an average of 8.3 times per month to an average of 2.6 times per month following endolymphatic sac decompression (P = .006). Ninety-five percent of patients (18 of 19 patients) reported improvement in symptoms (frequency, duration, or intensity) of vertigo and 37% (7 of 19 patients) reported complete resolution of vertigo. Endolymphatic sac decompression significantly improved perception of physical health, as well as symptom-specific outcomes, in patients with medically intractable Meniere's disease.

Intratympanic gentamicin treatment after endolymphatic sac surgery

Conclusions. Interval treatment with up to three intratympanic gentamicin injections once weekly effectively controlled vertigo while preserving hearing in patients with Ménière's disease and recurrent or resistant vertigo after saccotomy. Objectives. Recurrent or resistant incapacitating vertigo may occur after endolymphatic sac surgery (saccotomy) in patients with Ménière's disease. In these patients, revision saccotomy, vestibular nerve section or labyrinthectomy are the established treatment options. We advocate a once-weekly application of intratympanic gentamicin (12 mg) as an effective alternative in this group of patients. Material and methods. Five patients (age range 39–65 years) with definite Ménière's disease according to the 1995 American Academy of Otolaryngology—Head and Neck Surgery (AAO—HNS) criteria and incapacitating vertigo underwent gentamicin treatment after saccotomy. Control of vertigo and hearing preservation were the aims of treatment. The follow-up period ranged from 26 to 59 months. History and pure-tone audiometry were used to assess vertigo control and hearing, respectively. The frequency of vertigo in the 6-month period before gentamicin treatment ranged between 0.5 and four definitive episodes per month. Hearing stage (AAO—HNS criteria) before gentamicin treatment ranged between 2 and 4. Pre- and post-treatment pure-tone hearing thresholds at 0.5, 1, 2 and 3 kHz were compared by means of the Mann–Whitney U-test. Results. Complete vertigo control (class A; AAO—HNS) and hearing preservation at 0.5, 1, 2 and 3 kHz were achieved.

Local Overpressure Treatment Reduces Vestibular Symptoms in Patients with M??ni??re's Disease: A Clinical, Randomized, Multicenter, Double-Blind, Placebo-Controlled Study

To evaluate the efficacy of a new device, the Meniett, in the treatment of Meniere's disease. The device delivers pressure pulses to the middle ear through a ventilating tube in the tympanic membrane at a frequency of 6 Hz for 0.6 second. After rising to a pressure level of 1.2 kPa, the pressure oscillates between 0.4 and 1.2 kPa. It is believed that the pressure changes are conveyed to the inner ear, inducing a transport of fluids via the pressure outlets and thus reducing the endolymphatic hydrops. A clinical, randomized, multicenter, double-blind, placebo-controlled study. A total of 40 patients were included that had active Meniere's disease according to American Academy of Otolaryngology-Head and Neck Surgery criteria, aged between 20 and 65 years, with a history of at least eight attacks during the past year. After insertion of the ventilation tube, the patients should have had attacks of vertigo for 2 months before entering the study. Primary study endpoints were change in frequency of vertigo, change of functionality profile, and change in patient perception of vertigo (visual analogue scale); secondary endpoints were perception of tinnitus, aural pressure, and hearing, as well as an audiologic evaluation of hearing before and after the treatment period. The functionality level improved statistically significantly in the active group compared with the placebo group (p=0.0014), as did the visual analogue scale evaluation of vertigo (p=0.005). There was a trend toward a reduction of the frequency of vertiginous attacks that was not significant (p=0.090). With regard to the secondary endpoints, there was no statistical difference between active and placebo groups. Local overpressure treatment is a novel treatment that is noninvasive, nondestructive, and safe. It significantly reduces vestibular symptoms in patients with Meniere's disease. The Meniett was cleared by the Food and Drug Administration in 2000.