Intratympanic Gentamicin Research Articles

Middle Ear Gentamicin-Soaked Pledgets in the Treatment of Ménière’s Disease

Assess the relative efficacy and results of the round window hyaluronic acid pledget depot method for intratympanic gentamicin delivery in Ménière's disease. Retrospective case review. Tertiary referral hospital. Prospective symptomatic and audiologic data were collected on 28 patients undergoing intratympanic gentamicin therapy for Ménière's disease refractory to medical treatment between 2003 and 2009. All patients had the round window membrane exposed via a tympanomeatal flap, and any adhesions were removed. Hyaluronic acid pledgets soaked in 40 mg/ml of gentamicin were then packed into the round window niche and posterior mesotympanum, and the tympanomeatal flap was replaced. Patients audiologic and vertigo symptom outcome scores were recorded at follow-up according to the AAO-HNS 1995 guidelines for reporting results in Ménière's disease. Complete or substantial improvement in vertigo (class A or B) was achieved in 88.5% (23/26) of patients. Hearing loss, defined as greater than 10 dB (PTA average at 0.5, 1, 2, and 4 kHz) was noted in 12 (50%) of 24 patients including 4 patients who had developed "dead ears" (16%). The average hearing loss for all patients excluding the 4 patients with dead ears was 10.7 dB. Round window hyaluronic acid pledget technique used as a sustained delivery vehicle for intratympanic gentamicin treatment for Ménière's disease produces similar rates of vertigo control compared with other techniques but a greater risk of hearing loss. We would recommend the intratympanicinjection titration technique as first line for most patients.

Intratympanic Gentamicin for Ménière's Disease: Short‐ and Long‐term Follow‐up of Two Regimens of Treatment

(1) To compare the results of the 2 regimens of treatment at 2-year follow-up and (2) to evaluate the need and the efficacy of retreatment after the recurrence of vertigo attacks in a longer period of follow-up (using the Kaplan-Meier method of analysis). Retrospective chart review. Tertiary referral center. We analyzed 77 patients treated with intratympanic gentamicin (ITG). Thirty-five patients were treated with high-dose (HD) ITG (in total 6 injections, twice a day, repeated every 3 days) and 42 with low-dose (LD) ITG (1-2 injections). The results of treatment were evaluated in terms of functional level scale, control of vertigo, and hearing impairment. At 2-year follow-up, a similar percentage of vertigo control was obtained in the 2 groups; the incidence of hearing loss and posttreatment disequilibrium was significantly higher in patients treated with HD-ITG. The long-term follow-up showed a control of vertigo attacks with a single round of treatment in 71.4% of patients treated with HD-ITG and in 55% of those treated with LD-ITG. With repeated rounds, an effective control of vertigo could be achieved in 88.5% using a HD-ITG protocol and 97.7% using a LD-ITG protocol. LD-ITG allows obtaining good results in term of vertigo attacks associated with a limited occurrence of side effects. The long-term follow-up showed that LD-ITG needed repeated rounds more frequently than the HD-protocol. HD-ITG ran less risk of needing repeated rounds, but retreatment was ineffective in 40% of the cases requiring surgical therapy.

Tratamiento farmacológico de los acúfenos: mucho ruido y pocas nueces

Chronic tinnitus affects 5-15% of the general population; in 1% of individuals with tinnitus this condition severely affects their quality of life. Pharmacological treatment is one of the options for the management of tinnitus patients, but their efficacy remains controversial. AIM. To evaluate the level of evidence to support the use of different drugs in reducing the severity of tinnitus. The pharmacological groups that have been investigated for the treatment of tinnitus include anesthetics, anticonvulsants, antidepressants, antihistamines, benzodiazepines, diuretics, corticosteroids, and of other substances. Intravenous lidocaine seems to be effective, but the short duration of the effect and the adverse reactions prevent its use. Compared with placebo, carbamazepine and gabapentine have not demonstrated effectiveness although they may be effective in some patients with auditory nerve vascular compression or myoclonus. Tricyclic antidepressants are no more effective than placebo at reducing tinnitus severity although they may improve comorbid depression. There is insufficient evidence to evaluate the effectiveness of selective serotonin reuptake inhibitors and benzodiazepines. Acamprosate may decrease the severity of tinnitus, but the level of evidence is low. There are no consistent results in the studies with intratympanic gentamicin or steroids in tinnitus associated with Meniere's disease. The use of pharmacotherapy in reducing the severity of tinnitus is not well supported by prospective, randomized, placebo-controlled clinical trials. Various drugs have been shown to be effective in some studies, but the clinical evidence is limited. Large randomized clinical trials are needed.

Successful treatment of relapsed Ménière’s disease using selective serotonin reuptake inhibitors: A report of three cases

Patients with Ménière’s disease who have relapsed following endolymphatic sac surgery (EDS) or intratympanic gentamicin injection are occasionally treated with intratympanic gentamicin injections or revision surgery. However, there is a potential link between Ménière’s disease and anxiety or depression. The use of serotonin selective reuptake inhibitors (SSRIs) is likely be beneficial in the treatment of patients with Ménière’s disease. The aim of this report is to describe the benefits of SSRIs in patients with relapsed Meniere’s disease. Over the course of two years, three patients were treated for symptoms associated with Ménière’s disease with an SSRI (sertraline), with the complete resolution, or significant improvement, of symptoms. In these cases, the SSRI may have treated the associated morbidity and not Ménière’s disease itself. Ménière’s disease that appears to be resistant to typical otological treatment may not be just Ménière’s disease. Ménière’s disease may co-exist with three other conditions that are able to cause vestibular symptoms and respond to SSRIs: migraine-associated vertigo (MAV), panic disorders and chronic subjective dizziness (CSD).

Gentamicin Concentration Gradients in Scala Tympani Perilymph following Systemic Applications

It has been shown in prior studies that round window membrane (RWM) application of gentamicin produced a robust basal-apical concentration gradient in the perilymph of scala tympani (ST) with peak concentrations in the basal turn of ST. These gradients potentially contribute to the clinical efficacy and safety of intratympanic gentamicin applications for the treatment of Ménière's disease. The present study aimed to establish the distribution of gentamicin along ST perilymph after systemic applications. Gentamicin sulfate was applied intravenously in the amounts of 100, 300 and 600 mg/kg body weight (BW) over a period of 3 h or as a 300 mg/kg BW subcutaneous bolus injection. At 3 and 5 h after the start of the application perilymph of ST was aspirated from the cochlea apex of the right and left cochlea, respectively, and 10 sequential 1-µl perilymph samples from the apex of each cochlea were quantitatively analyzed using a fluorescence polarization immunoassay. In contrast to local RWM delivery, systemic application of gentamicin resulted in the highest perilymph levels in the apex of the cochlea with decreasing concentrations towards the basal regions of ST. The absolute gentamicin concentrations increased with the amount of drug applied and time before sampling. While it is likely that the basal-apical gradient measured after local drug applications to the round window niche is the result of the direct uptake of drugs into the perilymph of the ST, distribution by diffusion and a very low perilymph flow towards the cochlear apex, computer simulations suggested that the apical-basal gradient observed with these systemic applications can be explained by higher entry rates of gentamicin in the apex compared to the basal turns of the cochlea. It is also possible that gentamicin enters perilymph indirectly from the blood via the endolymph. In this case the faster kinetics in apical turns could be due to the smaller cross-sectional area of ST relative to endolymph in the apical turns.

Cochrane Analysis on Betahistine Omitted

Vertigo presents a trans-disciplinary challenge and it is therefore understandable that the neurologists establishing guidelines also include Meniere’s disease, a disorder of the inner ear. Unfortunately, Meniere’s disease causes not only vertigo in affected persons but also uncertainty among treating physicians, since even the etiology of the disease is uncertain—except for the physical final stage. It is perfectly understandable that the authors present their research into the subject. Even though it seems highly unlikely that a detected increase in circulation (in animal ears) can actually influence the course of Meniere’s disease (2). We fail to understand, however, why the Cochrane analysis on betahistine was not included in the certified CME article, whereas it was included in the report on reliably effective intratympanic gentamicin therapy. In the analysis it says that, although the drug is well liked by prescribers, a review of the seven studies accepted by the reviewers, which included a total of 243 patients, could not find evidence that betahistine works. It is stated in the review that most of the commissioned studies show favorable results, but are not valid (1). The observational study cited by Strupp et al.—their own—has at best important limitations, like its follow-up study, which raises doubt as to what type of vertigo can be assessed regarding its course (3). Even though the limited space of a reader’s letter leaves little room for substantial discussion, the suggestion seems that betahistine influences patients’ and treating physicians’ hopes rather than the Meniere’s disease itself. What is left out in this context is the fact that disappointed hopes constitute a serious adverse effect. We furthermore think it is tragic that betahistine in the meantime is prescribed far too often in cases where Meniere’s disease is only suspected.

Endolymphatic Sac Surgery Versus Intratympanic Gentamicin for the Treatment of Intractable Ménière’s Disease

1) To review a 10-year experience of endolymphatic sac surgery (ESS) and intratympanic gentamicin (ITG) for intractable Ménière's disease (MD), and 2) to compare preoperative and postoperative outcomes. Retrospective chart review and survey. Tertiary care center. Patients treated with ESS or ITG between 1997 and 2007 at London Health Sciences Centre were eligible for recruitment. ESS or ITG. 1) 1995 American Academy of Otolaryngology-Head and Neck Surgery hearing stage, vertigo class, and functional level; and 2) a 40-item validated quality-of-life questionnaire (MD Outcome Questionnaire). Chi-squared and t tests. Sixty-seven patients were recruited (n = 30 ESS; n = 37 ITG). Preoperatively, the ITG group had poorer hearing stage (p = 0.03). There were no differences between groups on preoperative functional level and QOL measures. Postoperatively, ESS patients reported more tinnitus (p = 0.003) and aural fullness (p = 0.01). There were no differences in posttreatment vertigo class. Secondary treatment was required for 27% of patients in the ESS compared with 3% in the ITG. Posttreatment hearing remained unchanged for the ITG and was overall decreased in the ESS group (p = 0.03). Participants in the ITG reported better postoperative functional levels (p = 0.02) and higher global (p = 0.04), social (p = 0.001), and overall QOL scores (p = 0.03). ITG, compared with ESS, reveals better posttreatment functional levels, and superior global, social, and overall QOL scores. Although no statistical difference in vertigo class, a clinical difference is observed.

Inner ear insult ablates the arousal response to hypoxia and hypercarbia

IntroductionSudden Infant Death Syndrome (SIDS) remains the leading cause of infant mortality in Western societies. A prior study identified an association between hearing suppression on the newborn hearing test and subsequent death from SIDS. This is the first finding of an abnormality in SIDS cases prior to death. A following study identified that inner ear dysfunction precipitates a marked suppression of the hypercapnic ventilatory response (HCVR). Failure of arousal has been proposed to be a key component in SIDS. The objective of the present study was to assess whether inner ear dysfunction not only weakens the hypercapnic response, but also plays a role in suppressing the arousal response to suffocating gas mixtures. MethodsWild-type mice (n=28) received intra-tympanic gentamicin (IT-Gent) injections bilaterally or unilaterally to precipitate inner ear hair cell dysfunction. Three control groups (n=22) received intra-tympanic saline (IT-Saline) bilaterally or unilaterally (right or left), or intra-peritoneal gentamicin (IP-Gent). The body movement arousal responses to severe hypoxia–hypercarbia combined (5% CO2 in nitrogen) were tested under light anesthesia 8days following the administration of gentamicin or saline. ResultsAfter injections, the bilateral and unilateral IT-Gent-treated animals behaved similarly to controls, however the HCVR as well as the arousal movements in response to severe hypoxia–hypercarbia were suppressed in IT-Gent-treated animals compared to control animals (P<0.05). Thus the HCVR was significantly decreased in the bilateral (n=9) and unilateral IT-Gent-treated mice (n=19) compared to bilateral (n=7) and unilateral IT-Saline (n=9) control groups (p<0.05). Arousal movements were suppressed in the bilateral IT-Gent group (n=9) compared to bilateral IT-Saline controls (n=7, P<0.0001) and in the unilateral IT-Gent group (n=19) compared to unilateral IT-Saline controls (n=10, P<0.0001). DiscussionThe findings support the theory that inner ear dysfunction could be relevant in the pathophysiology of SIDS. The inner ear appears to play a key role in arousal from suffocating gas mixtures that has not been previously identified.

Preclinical and Clinical Studies of Unrelieved Aural Fullness following Intratympanic Gentamicin Injection in Patients with Intractable Ménière's Disease

Objective: To clarify whether gentamicin affects vestibular dark cells in guinea pigs and relieves patients of aural fullness with intractable Ménière's disease following intratympanic administration. Materials and Methods: Purified gentamicin-Texas Red (GTTR) was injected intratympanically in guinea pigs that were sacrificed at 1, 3, 7, 14 and 28 days. GTTR uptake was examined in hair cells, and transitional cells and dark cells in vestibular end-organs were examined. Specific attention was paid to its distribution in dark cells under confocal microscopy, and the ultrastructure of dark cells using electron microscopy, following intratympanic injection. Results: Dark cells in the semicircular canals showed weak GTTR uptake at 1, 3, 7, 14 and 28 days after intratympanic injection, with no significant differences at various time points after injection. However, the adjacent transitional cells demonstrated intense GTTR uptake that was retained for at least 28 days. Ultrastructural studies demonstrated negligible characteristics associated with apoptosis or necrosis in these dark cells. The tight junctions between dark cells showed no signs of disruption at 7 or 28 days after injection. Conclusion: Intratympanic gentamicin has little direct impact on vestibular dark cells. Clinical Application: A modified low-dose titration intratympanic approach was used in 29 patients with intractable vertigo and the clinical outcomes were followed. Aural fullness following intratympanic gentamicin injection was not relieved based on our subjective scales, demonstrated by no statistically significant difference between preinjection (4.16 ± 3.08) and postinjection (3.58 ± 2.93; p > 0.05) aural fullness scores. Vertigo control was achieved in 88% of patients, with hearing deterioration identified in 16% of patients. Intratympanic gentamicin administration might not lead to relief of aural fullness in patients with intractable vertigo, although it can achieve a high vertigo control rate with some cochleotoxicity.

A1555G Polymorphism and Aminoglycoside‐induced Hearing Loss from Intratympanic Gentamicin Therapy

Objectives: Intratympanic gentamicin (ITG) treatment has become a standard modality in treating patients with Ménière’s disease (MD) with high success rate. However, 30% of the ITG patients may suffer from further hearing recession. The relation of a genetic variation in the mitochondrial rRNA gene, A1555G, and aminoglycoside-induced hearing loss (AIHL) remains unknown. The aim of the present study was to evaluate whether the presence of A1555G polymorphism in the mitochondrial rRNA gene can predispose to the AIHL in MD patients following ITG. Methods: 33 Ménière’s disease patients received ITG therapy. Genomic DNA was extracted from their blood samples. Target fragment within mitochondrial rRNA gene was amplified by polymerase chain reaction, and genotyped by direct sequencing to search for 1555 A-to-G substitution. Results: 33 patients (13 males and 20 females; mean age: 56.2 years old) met the inclusion criteria. None of the subjects demonstrated this specific A-to-G substitution. Whether the patients will suffer from AIHL is independent of the presence of A1555G polymorphism. Conclusions: ITG treatment for intractable Ménière’s disease appears to be effective in the relief of vertigo. However, we disagree with the relationship between A1555G polymorphism and antibiotic-induced ototoxicity reported by Prezant et al. There might be different significant single nucleotide polymorphisms that may predispose to the hearing loss following ITG treatment. Further genotypes involving in this treatment must be analyzed in various populations.

Recurrent Vertigo after Intratympanic Gentamicin for Ménière's Disease: Long‐term Follow‐up of Two Regimens

Objectives: 1) Analyze the recurrence rate of vertigo and the need for repeated injections of two different regimens of intratympanic gentamicin (ITG) (low dose and multiple daily dose). 2) Evaluate the efficacy of retreatment after long-term recurrence of vertigo attacks. Methods: We retrospectively analyzed 2 series of patients suffering from unilateral Ménière’s disease treated with low dose ITG (42) and multiple daily dose ITG (35) in a tertiary referral center. The mean period of follow-up was 4.8 years, and the outcome measurements were a) control of vertigo attacks, b) need of repeated treatment for recurrent vertigo evaluated using the Kaplan-Meyer method, and c) incidence of side effects (post-treatment dizziness, hearing loss). Results: At 2-year follow-up, complete control of vertigo was obtained with only 1 round of treatment in 30 (71%) low dose patients and 28 (80%) multiple daily dose patients. Side effects of ITG were significantly higher in the multiple daily dose group. At long-term follow-up (&gt; 4 years), the complete control vertigo rate decreased significantly, especially in the low dose group. 13 (31%) patients in the low dose group and 9 (25%) in the multiple daily dose group needed multiple rounds of treatment. Conclusions: Both regimen of ITG offered an excellent rate of vertigo control at 2-year follow-up. At long-term follow-up, the probability of recurrent vertigo attacks progressively increases, especially in the low dose group. The patients who experienced late recurrences of vertigo had less chance of achieving good results with additional rounds of ITG.

The Use of Intratympanic Gentamicin in Patients With Vestibular Schwannoma and Disabling Vertigo

To document the effect of intratympanic gentamicin as treatment of disabling vertigo secondary to a vestibular schwannoma in elderly patients. Four elderly patients with a vestibular schwannoma, with an extrameatal diameter of less than 1 cm, experiencing disabling vertigo and followed a wait-and-scan policy. Intratympanic injection of gentamicin. Subjective improvement of quality of life and audiologic and vestibular assessment. We obtained a subjective improvement in the quality of life for all the 4 patients. In fact, disabling vertigo disappeared in all cases; 3 patients recovered their posttreatment unsteadiness after a period of vestibular rehabilitation, whereas one of them complained of persistent unsteadiness. The hearing remained unchanged in 3 patients, whereas in one, the pretreatment severe sensorineural hearing loss progressed to anacusis. This treatment represents an additional option in patients with small not-growing tumor affected by vestibular symptoms to be combined with a wait-and-scan policy.

Comparison of Intratympanic Methylprednisolone and Gentamicin for Ménière's Disease May Be Misleading

Comparison of Intratympanic Methylprednisolone and Gentamicin for Ménière's Disease May Be Misleading

Response to: Comparison of Intratympanic Methylprednisolone and Gentamicin for Ménière's Disease May Be Misleading

Response to: Comparison of Intratympanic Methylprednisolone and Gentamicin for Ménière's Disease May Be Misleading

Intratympanic gentamicin treatment ‘as needed’ for Meniere’s disease. Long-term analysis using the Kaplan–Meier method

In recent years, several titration or on-demand protocols using low-dose repeated intratympanic (IT) gentamicin injections have been adopted for the vertigo control in unilateral medical refractory Menière's disease (MD). Because of the frequent recurrence and the need to treat the patients several times, it is difficult to strictly follow the 1995 AAO-HNS criteria to classify the results. The Kaplan-Meier analysis provides an effective and simpler method to address these concerns. We report the results of a long-term study (7 years) on a large population of MD patients (174) treated with on-request low-dose delayed IT gentamicin injections analysed using the Kaplan-Meier survival method. Effective vertigo control was obtained with a single injection in 40.2% of the patients (excellent responders) and with repeated injections (2-9) in 43.7% of the patients (moderate responders). Only six patients (3.5%) needed to be submitted to vestibular neurectomy because of the persistence of vertigo attacks (non-responders). A subgroup of 22 patients (12.6%) reporting a late recurrence of vertigo attacks after an initial vertigo-free interval lasting more than 2 years (short-term responders) were successfully treated with a further cycle of injections. In no cases, we observed significant signs of cochlear or vestibular toxicity. Kaplan-Meier survival analysis provided an excellent method for reporting treatment success or failure in patients followed for variable length of time with our kind of protocol.

Gentamicin‐induced bilateral vestibulopathy in rabbits

Bilateral vestibulopathy (BV) is a mostly persistent and disabling disorder causing dizziness, oscillopsia, and imbalance during locomotion. The animal model is a prerequisite for experimental investigation on prevention and treatment of this disorder. The aim of this study was to determine the vestibular dysfunction and histopathology in rabbits with gentamicin-induced BV. Prospective animal study in rabbits. We performed intratympanic gentamicin (ITGM) injections in 12 Lionhead rabbits. The injection was applied to each ear with a 3-day interval. The control group received injections of 0.9% normal saline. The animals were subjected to sinusoidal harmonic accelerations and open field tests for evaluation of the vestibular function before and after the procedures. We also determined histologic changes in the vestibular labyrinth 30 days after the first injection. One day after unilateral ITGM injection, the rabbits mostly showed ipsiversive head tilt, contralesional spontaneous nystagmus, ipsiversive circling behavior, and decreased gain of the vestibulo-ocular reflex (VOR) during ipsiversive rotation. The second injection to the contralateral ear improved the head tilt but induced marked reduction in the activities and the VOR gains in both directions. These changes persisted until the histologic study confirmed the loss of the hair and supporting cells, diminished nerve fibers, and thinning of the sensory epithelium of the cristae ampullaris and otolith organs in the ITGM group 1 month later. ITGM injection securely induced BV in rabbits without side effects such as nephrotoxicity. This rabbit model may be utilized for experiments on the prevention and treatment of BV.

The Effect of Intratympanic Methylprednisolone and Gentamicin Injection on Ménière's Disease

To compare the efficacy of intratympanic injections of methylprednisolone (ITMP) and intratympanic injections of gentamicin (ITG) to control the symptoms of Ménière's disease and to evaluate their effect on hearing level. A historical cohort study. Tertiary referral center. Eighty-nine patients affected by Ménière's disease were included in this study, of whom 47 were treated with ITG and 42 were treated with ITMP. Two periods of follow-up were considered: 0 to 6 months and 6 to 12 months after the intratympanic injections (ITI). Mean outcome measurements consisted of control of vertigo attacks, tinnitus, and aural fullness; pure-tone average (PTA); and speech discrimination score (SDS). The 2 groups had the same number of vertigo spells per month before ITI (P = .883). Six to 12 months after ITI, 82.9% of the ITG group and 48.1% of the ITMP group achieved complete control of vertigo (P = .004). There was better control of tinnitus and aural fullness with ITG than with ITMP (P ≤ .002). The 2 groups had a statistically significant difference in hearing level before ITI (P ≤ .001). This difference was no longer present 6 to 12 months after ITI (P > .05). Intratympanic injections of gentamicin are more efficient than ITMP in controlling the symptoms of Ménière's disease. The 2 groups ended up without a difference in hearing level after ITI. According to these findings, administrating ITMP to control Ménière's disease seems to be less beneficial than ITG.

Dynamic Change of VOR and Otolith Function in Intratympanic Gentamicin Treatment for Ménière’s Disease: Case Report and Review of the Literature

Intratympanic gentamicin treatment (IGT) is an evidence-based therapeutic option for recurrent vertigo attacks in Ménière's disease (MD). Today, in MD it is possible to monitor changes of vestibular receptor function, induced by IGT, with objective test methods such as the video head impulse test (vHIT) and cervical and ocular vestibular evoked myogenic potentials (cVEMP, oVEMP) in a dynamic, time-and frequency-dependent manner. We report on a 65-year-old female patient with recurrent vertigo attacks in a right-sided MD, where receptor function was followed up before and up to 4 weeks after IGT (time dynamic). Quantitative changes of vestibular function (frequency dynamic) were detected with bithermal calorics and vHIT, with air-conducted sound (ACS) cVEMP and bone-conducted vibration (BCV) oVEMP at 500 Hz. The horizontal vestibuloocular reflex (hVOR) gain in vHIT decreased successively until the 4th week with the appearance of catch-up covert and catch-up overt refixation saccades, and side asymmetry increased in caloric testing. Saccular function was extinguished within 4 weeks, whereas utricular function was diminished after 4 weeks. Monitoring vestibular receptor function with objective test methods provides a quantitative insight into the dynamic activity of vestibular function and is therefore applicable in order to adjust IGT regimen at different therapeutic stages.

Intratympanic gentamicin treatment for unilateral Ménière's disease: long-term follow up of a proven regime

To determine the long-term efficacy of a fixed-dose intratympanic gentamicin treatment regime in controlling unilateral Ménière's disease. Pfleiderer (1998) published two-year follow-up results for a series of 16 patients treated with a 4-day, 12-dose intratympanic gentamicin regime for unilateral Ménière's disease that was refractory to medical treatment. In 2010, a long-term telephone follow up (mean 17 years and 3 months) of this same cohort was conducted to determine long-term vertigo control. Of the 16 patients, 13 were eligible for the long-term follow up. At 2 years' follow up, all 16 patients experienced substantial control of vertigo, with complete control achieved in 87 per cent of cases. At the long-term follow up, 9 of the 13 eligible patients were contactable, and all reported complete control of vertigo. Fixed-dose intratympanic gentamicin controlled symptomatic unilateral Ménière's disease in both the short and long term.

Endolymphatic hydrops perspectives 2012

Endolymphatic hydrops remains a significant cause of morbidity secondary to vertigo, hearing loss, and tinnitus. The purpose of this report is to summarize the most clinically relevant publications on endolymphatic hydrops over the past 2 years. Hydrops has historically been a diagnosis of exclusion, but recent efforts has shown a role for MRI with intratympanic gadolinium. Cochrane reviews of intratympanic dexamethasone and gentamicin found inadequate level 1 evidence to support their use. High-level evidence to guide therapy is lacking. MRI holds potential for definitive diagnosis.