Intratympanic Gentamicin Injection Research Articles

Intratympanic gentamicin therapy for intractable Ménière's disease

Conclusions. Intratympanic gentamicin treatment using a low dose of gentamicin (∼21–24 mg per injection) applied at intervals of a minimum of 27 days, has been shown to be a successful treatment of vertigo. Objectives. The objective of this analysis was to evaluate the efficacy and side effects of intratympanic injections of gentamicin as treatment of intractable unilateral Ménière's disease. Patients and methods. This was a retrospective study in which 57 patients treated with intratympanic gentamicin for Ménière's disease were analysed. Patients received between 1 and 10 intratympanic injections of gentamicin in an outpatient setting. Results. Six months after treatment, overall complete or substantial vertigo control was reported by 80.7% of our patients (VCC class A, 61.4%; class B, 19.3%). Unilateral caloric weakness increased from 50.1% to 79.8% after treatment, and complete caloric areflexia (30°C and 44°C) was induced in 38.6%. In this study hearing worsened (>10dB = SNHL) in only 15.8% of our patients (range 10–29 dB) and loss of word recognition (WR) scores worsened (>15%) in 31% of the patients. Only 1 injection was necessary in 49.1% of the patients, the remaining 50.9% needed 2, 3, 4, 6 or 10 injections, always with a time interval of a minimum of 27 days.

Effects of a single intratympanic gentamicin injection on Meniere's disease

Conclusion. Both single and multiple injections of ITGM were effective in vertigo control and functional improvement. However, the risk of sensorineural hearing loss was much lower for a single injection than for multiple injections. Objectives. While intratympanic gentamicin injection (ITGM) has been established as treatment option for intractable Meniere's disease, several injection protocols have been introduced. The risk of sensorineural hearing loss (SNHL) has been reported to be variable for each protocol. Among the protocols, the single injection protocol is an easy to administer, well-tolerated and cost effective technique, as compared with others. We compared the clinical efficacy of ITGM with regard to the vertigo control rate and the incidence of SNHL between two different protocols: the use of single and multiple injections. Materials and Methods. A retrospective review was conducted for 30 subjects who were treated with ITGM with intractable unilateral Meniere's disease from May 1997 through February 2005. The patients were divided into two groups according to the protocol utilized: the multiple injection group (n =10) and the single injection group (n =20). Treatment efficacy was evaluated by using the AAO-HNS Committee on Hearing and Equilibrium guidelines (1995). Results. Effective vertigo control (Class A and B) were accomplished in 90% of patients in the multiple injection group and in 90% of patients in the single injection group. Functional status was also markedly improved in both groups. However, a significant hearing loss occurred more frequently in the multiple injection group (71%) than in the single injection group (5%). The rate of caloric loss was not different for the two groups (88% for the multiple injection group vs. 85% for the single injection group).

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.

Intratympanic gentamicin for Ménière's disease: effect on quality of life as assessed by Glasgow benefit inventory

To evaluate patients' quality of life after receiving intratympanic gentamicin as treatment for Ménière's disease. Retrospective study using the Glasgow benefit inventory scale (GBI) questionnaire. Patients diagnosed with Ménière's disease, according to the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) diagnostic criteria (refractory to medical management), who were treated with intratympanic gentamicin injection. This retrospective study included all patients diagnosed with Ménière's disease (according to AAO-HNS criteria; refractory to medical management) undergoing gentamicin labyrinthectomy in our unit over the preceding three years. Other causes of hearing loss were ruled out as all patients underwent magnetic resonance imaging, electronystagmography and sway magnetometry. Patients underwent gentamicin infiltration at a concentration of 2 ml of 30 mg/ml and were reviewed six weeks later and received a repeat injection if no benefit was evident. Six months after their last follow up, they were sent a GBI questionnaire. Twenty-one questionnaires were posted, and the response rate was 81 per cent. As per the responses received, the total benefit of intratympanic gentamicin injection was found to be +30.3. The three components of GBI were analysed separately; it was found that general benefit was greatest (+33.3), followed by physical benefit (+28.1) and social benefit (+21.6). This study suggests that gentamicin definitely improves quality of life in patients with Ménière's disease and should be the first line of treatment if medical management fails.

Pharmacological advances in the treatment of neuro-otological and eye movement disorders

First, to describe the current pharmacological treatment options for peripheral and central vestibular, cerebellar, and ocular motor disorders. Second, to identify vestibular and ocular motor disorders in which treatment trials are warranted. Peripheral vestibular disorders: In vestibular neuritis recovery of the peripheral vestibular function can be improved by treatment with oral corticosteroids. In Ménière's disease treatment strategies range from low-salt diet, diuretics, and betahistine, to intratympanic injection of corticosteroids or gentamicin. Unfortunately most of the trials on Ménière's disease do not have an up-to-date design. In bilateral vestibulopathy steroids do not seem to improve vestibular function.Central vestibular, cerebellar, and ocular motor disorders: The use of aminopyridines introduced a new therapeutic principle in the treatment of downbeat and upbeat nystagmus and episodic ataxia type 2 (EA2). These potassium channel blockers presumably increase the activity and excitability of cerebellar Purkinje cells, thereby augmenting the inhibitory influence of these cells on vestibular and cerebellar nuclei. A few studies showed that baclofen improves periodic alternating nystagmus, and gabapentin and memantine, pendular nystagmus. Many other eye movement disorders, however, such as ocular flutter, opsoclonus, central positioning, or see-saw nystagmus are still difficult to treat. Although progress has been made in the treatment of vestibular neuritis, downbeat and upbeat nystagmus, as well as EA2, state-of-the-art trials must still be performed on many vestibular and ocular motor disorders, namely Ménière's disease, bilateral vestibulopathy, vestibular paroxysmia, vestibular migraine, and many forms of central eye movement disorders.

Angular Vestibulo-Ocular Reflex Gains Correlate with Vertigo Control after Intratympanic Gentamicin Treatment for Meniere's Disease

The objective of our study was to determine whether angular vestibulo-ocular reflex (aVOR) gains correlated with vertigo control after intratympanic gentamicin treatment for Meniere's disease. We conducted a prospective study of 18 subjects with unilateral Meniere's disease treated with intratympanic gentamicin injection and followed all subjects for 1 year. We measured the gain of the aVOR elicited by rapid rotary head thrusts in each of the canal planes for each subject before and after treatment with intratympanic gentamicin by using magnetic search coils to record eye movements. During the follow-up period, 11 subjects ("single-treatment group"; 61%) had control of their vertigo with a single gentamicin injection. The remaining 7 subjects ("multiple-treatment group"; 39%) experienced recurrent vertigo that required a second injection of gentamicin at a mean of 6 months after the first treatment. The 11 subjects in the single-treatment group had significantly greater reduction of labyrinthine function after the first treatment, as measured by change in ipsilateral horizontal canal gain, than did the 7 subjects with vertigo recurrence. Changes in caloric asymmetry did not correlate with vertigo control. Our results suggest that successful treatment of Meniere's disease is closely related to attenuation of semicircular canal function as measured by horizontal canal aVOR gains.

Endothelial nitric oxide synthase upregulation in the cochlea of the guinea pig after intratympanic gentamicin injection

Single-shot transtympanic gentamicin therapy has become a popular treatment modality for Meniere's disease despite the known possible ototoxic properties of this drug. It was shown recently that NO production and iNOS were upregulated after gentamicin application, which was interpreted as a possible effect of ototoxicity. In this study we analyzed the expression of eNOS after gentamicin application to determine a possible correlation of this enzyme with gentamicin-induced ototoxicity. We compared eNOS expression in gentamicin-treated and non-treated guinea pigs in the second turn of the cochlea, an area corresponding to speech perception in humans. Gentamicin (4 mg) was injected intratympanically into the middle ear of guinea pigs ( n =3) and the reduction of the hearing threshold level was determined by recording acoustic-evoked potentials (AEP) before and 5 days after gentamicin application. Morphological alterations in the organ of Corti were analyzed by light and electron microscopy. Gold-labeled anti-eNOS antibodies were counted in eight different cell areas for quantification of eNOS expression. Seven animals were analyzed as controls. After gentamicin application, a deterioration of hearing level was observed varying from 10 to 30 dB. A high degree of vacuolization was identified in the third row of outer hair cells. At the subcellular level, the subsurface cisterns in outer hair cells were dissociated from the basolateral cell membrane, and the mitochondrial membranes were frequently damaged. Statistically significant upregulation of eNOS was observed in all cell types analyzed. Depending on the various cell types the amount of gold-labeled eNOS antibodies was 2.5 to 5.7 times higher after gentamicin application. We observed significant eNOS upregulation after gentamicin application in the cochlea, in conjunction with cellular damages and decreased hearing.

Distortion Product Otoacoustic Emissions after Intratympanic Gentamicin Therapy for Unilateral Ménière’s Disease

The treatment of patients with Ménière’s disease that do not respond to conventional therapy becomes complicated, particularly when taking into account the issue of hearing damage as well as the control of vertigo. Treatment often involves the intratympanic administration of gentamicin, for which different protocols are used. Hence, it is important that we better understand how this treatment influences hearing, beyond mere audiometric assessments. The aim of this prospective study was to evaluate the effect of intratympanic gentamicin treatment for Ménière’s disease on cochlear function, as assessed by otoacoustic emissions. The 41 patients included in the study had been diagnosed with unilateral Ménière’s disease as defined by the American Academy of Otolaryngology-Head and Neck Surgery guidelines (1995), and had been refractory to medical treatment for at least 1 year. Intratympanic injections of gentamicin at a concentration of 27 mg/ml were performed at weekly intervals until indications of vestibular hypofunction appeared in the treated ear. Before beginning the treatment and 3 months after ending it, pure tone and speech audiometry tests were performed and the results are expressed in terms of the pure tone average (0.5, 1, 2, and 3 kHz) and the speech discrimination score, respectively. At the same time, a distortion product otoacoustic emission (DPOAE) study was performed and the results are expressed in terms of its presence or absence, and as the amplitude and threshold of the emission. When analyzed 3 months after the treatment had terminated, hearing loss was seen in 13 patients (31.7%). However, no significant change in the threshold and/or amplitude of otoacoustic emissions was observed in any of the patients. Neither were changes in the audiometric stage, number of injections required or the existence of DPOAE before treatment detected. Hence, the treatment method used here for patients with intractable unilateral Ménière’s disease can be considered as having a low risk on auditory function, as assessed both audiometrically and with otoacoustic emissions, and can be considered as subablative for hearing function.

Vestibular function at the end of intratympanic gentamicin treatment of patients with Ménière's disease

The aim of this study is to analyze the effects of intratympanic gentamicin injections on vestibular function in 33 patients with unilateral Meniere's Disease (according to AAO-HNS guidelines 1995) that had been unresponsive to medical therapy for at least one year. In such patients, the results of bedside examination of vestibular function vestibular examination is compared to those from laboratory tests. Intratympanic gentamicin injections (27 mg/ml) were performed at weekly intervals until symptoms or signs of vestibular hypofunction developed in the treated ear. Vestibular function was evaluated in two different rotatory chair tests. The parameters that were specifically considered were the time constant of the vestibulo-ocular reflex (VOR) after impulse rotation with a peak chair velocity of 100 degrees s(-1), and the phase and gain of the VOR after the sinusoidal harmonic acceleration (SHA) test with a peak chair velocity of 50 degrees s(-1). After treatment, both the time constant of the VOR after rotation towards the treated side and the gain in the SHA test were significantly reduced. These reductions were in accordance with the number of additional signs observed upon bedside examination at the end of the treatment. The changes observed in the VOR correlate well with the results of bedside examination of vestibular function, which in turn reflects the damage induced by intratympanic gentamicin injection.

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.

メニエール病，遅発性内リンパ水腫に対するゲンタマイシン鼓室内注入療法の長期成績

In this study, we reported the long term results of intratympanic gentamicin administration over 1 year after treatment for intractable Meniere's disease (MD) or delayed endolymphatic hydrops (DEH). Thirty-five patients (15 males and 20 females) were evaluated after 6.0 intratympanic gentamicin injections on average. The mean age was 44.5 years-old and the mean follow-up period was 68.2 months. The formula expressing the effect of treatment was based on AAOHNS criteria. Valid results of evaluation for more than twelve months in post-treatment were compared with those for six months in pre-treatment, expressed in percent. If the formula is 40% or less, the treatment is judged as effective. The efficacy rate of this treatment for definitive vertigo spells was 97%, and that for adjunct spells was 74%. The average hearing level of five frequencies before and after treatment was 68.5 dB and 74.0 dB, respectively. In eleven patients (31%), the hearing level deteriorated by 10 dB or more. Our results revealed that GM therapy was very effective in the long term for the treatment of vertigo. However, further refinement is needed to minimize adverse hearing deterioration. Methods to reduce adverse effects were discussed.

Vestibular function and vasopressin.

To investigate the relation between the vestibular system and vasopressin (AVP). We examined the effects of electrical and caloric vestibular stimulation on plasma AVP levels in anesthetized rats. Plasma AVP levels of patients with intractable Ménière's disease who were subjected to endolymphatic drainage and steroid instillation surgery (EDSS) or intratympanic gentamicin (GM) injection were measured before and after these interventions. Electrical vestibular stimulation increased plasma AVP levels in a current intensity-dependent manner. Plasma AVP levels were also increased by caloric stimulation with cold water. Plasma AVP levels decreased rapidly after EDSS, and were maintained at a low level even 6-12 months following EDSS or intratympanic GM injection. Vestibular activation or inhibition-induced imbalance of intervestibular activities increased plasma AVP levels in rats. Therefore, vestibular disorder would seem to increase plasma AVP and thus worsen endolymphatic hydrops. EDSS rapidly decreased plasma AVP and would seem to reduce hydrops. Inhibition of vertigo spells by EDSS or intratympanic GM injection would reduce a possible stress response, resulting in a decrease in plasma AVP levels a long time after the treatments. This resultant decrease in AVP would beneficially inhibit the formation and/or maintenance of hydrops and thus prevent vertigo spells.

Ménière's disease.

Ménière's disease is characterized by spontaneous attacks of vertigo, fluctuating sensorineural hearing loss, aural fullness, and tinnitus. The pathologic process involves distortion of the membranous labyrinth with the formation of endolymphatic hydrops. This review describes the pathogenesis and etiology as well as the diagnosis and treatment of Ménière's disease. Initial management of Ménière's disease can involve a low-salt diet and a diuretic. Treatment with intratympanic injection of gentamicin can be beneficial when vertigo persists despite optimal medical management. Recent studies have shown that gentamicin reduces vestibular function in the treated ear, although complete ablation of this vestibular function is not typically required in order to achieve control of vertigo. Vertigo is often the most debilitating symptom associated with Ménière's disease. Many treatment options exist for the management of vertigo. Intratympanic injection of gentamicin (low dose) can be used in patients for whom vertigo has not been controlled by medical measures. Ongoing research is providing a greater understanding of the effects of gentamicin on vestibular function and of the mechanisms through which gentamicin leads to control of vertigo.

Long-term results after interval therapy with intratympanic gentamicin for Menière's disease.

The new single-shot and interval treatment for Menière's disease with gentamicin was designed to avoid cochlear damage during treatment with gentamicin. To date, 90 patients were treated with the single-shot or interval gentamicin therapy. Fifty-seven cases of Menière's disease were followed up prospectively between 2 and 4 years. During one treatment series, a maximum of three intratympanic gentamicin injections within 15 days were applied, each consisting of 0.3 mL (12 mg) of gentamicin (days 1, 8, and 15). Thirty of these 57 patients (53%) needed only one injection to be controlled (single-shot treatment). Vertigo attacks were completely controlled in 95% and partially controlled in 5%, whereas hearing remained unchanged or even improved. Tinnitus as well as aural fullness were controlled in approximately 50% of the cases. Our results with this group of patients after interval-treatment or single-shot application of intratympanic gentamicin demonstrate the effectiveness of this treatment modality with very low side effects, and, although our experience is still limited, it allows for expanding the indication on early cases of Menière's disease before permanent hearing loss occurs. Even cases of bilateral Menière's disease can be treated successfully using this method. Cochleotoxic side effects can be prevented by treatment intervals of 7 days.

一側性メニエール病の両側移行例の検討：ゲンタマイシン鼓室内注入療法の適応検討の観点から

Intratympanic gentamicin injection has been used as a treatment of intractable Meniere's disease (MD). Although this therapy is supposed to be applied to unilateral MD, it should be noted that unilateral MD progresses to bilateral MD at a rate of 10-40%. Involvement of the contralateral ear after gentamicin injection could cause the serious problem of bilateral inner ear disfunction. To predict the future involvement of the contralateral ear, we reported a prospective study of patients that were diagnosed with unilateral MD at the first examination. Among 71 patients with unilateral MD, 9 (12.6%) showed fluctuating hearing loss in the contralateral ear. The average interval of the contralateral involvement after the unilateral involvement was 8.7 years. Although the prediction of the contralateral involvement was difficult from the results of the pure tone audiometry, caloric test and vestibular evoked myogenic potential, these bilateral cases tended to be seen more in females and in patients of older ages at the onset of the disease. The results of this study revealed that there is a possibility of contralateral involvement for more than 10 years, and the incidence of bilateral involvement is high in female patients who were over 60 at the onset of the disease.

Long-term hearing outcome in patients receiving intratympanic gentamicin for Ménière's disease.

To determine the long-term hearing outcome in patients with intractable vertigo caused by unilateral Ménière's disease who were treated with intratympanic injection of gentamicin. The study was a longitudinal analysis of hearing and control of vertigo in patients with unilateral Ménière's disease who received intratympanic gentamicin. Pure-tone thresholds and speech discrimination scores on audiometry were analyzed, along with the control of vertigo. Criteria described in 1995 by the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) were used. Patients treated with intratympanic gentamicin had "definite" Ménière's disease and had intractable vertigo despite optimal medical therapy, no symptoms suggestive of Ménière's disease in the contralateral ear, and serviceable hearing in the contralateral ear. The study analyzed the outcomes of 34 patients for whom follow-up data were available for periods greater than 24 months after intratympanic gentamicin. Complete control of vertigo (AAOHNS Class A) was obtained in 90% of the patients. Profound sensorineural hearing loss occurred as a result of gentamicin injection in 1 of the 34 patients (3%). When data from all patients were grouped together, hearing was improved in 5 (15%), unchanged in 23 (68%), and worse in 6 (17%) patients. This distribution of hearing outcome is similar to that in patients whose symptoms of Ménière's disease were managed with medical measures. Recurrent vertigo developed in 10 patients (29%) at an interval of 4 to 15 months after initially complete control. Treatment with additional intratympanic injection(s) of gentamicin did not result in a change in hearing. The risk of hearing loss in patients treated with infrequent intratympanic injection(s) of gentamicin is low.

Changes in the angular vestibulo-ocular reflex after a single dose of intratympanic gentamicin for Ménière's disease.

Meniere’s disease is an inner ear disorder that causes episodic vertigo, hearing loss, tinnitus, and fullness in the ear. The clinical disorder has been associated with hydrops, a distension of the endolymphatic fluid compartment of the inner ear. The majority of patients can successfully control their attacks of vertigo with diuretics and restriction of sodium intake. However, about 30% of patients with Meniere’s disease have intractable vertigo that does not respond to these measures. The intratympanic (middle ear) injection of gentamicin is now an alternative to ablative surgery for these patients. Gentamicin is an aminoglycoside antibiotic that is toxic to the hair cells of the inner ear, with somewhat greater vestibular toxicity than cochlear toxicity. We have treated 102 patients with unilateral Meniere’s disease with intratympanic gentamicin. Attacks of vertigo have been completely controlled in 83%, and substantially controlled (>60% reduction in frequency) in 12%. Profound hearing loss occurred as a result of treatment in only 2%, and the overall rate at which hearing declined after treatment (19%) did not differ from the expected decline in hearing with active Meniere’s disease. Recent evidence suggests that a single dose of intratympanic gentamicin can be effective in controlling vertigo in Meniere’s disease. 1 This study was undertaken to determine the effect of a single intratympanic injection of gentamicin on the function of the human angular vestibulo-ocular reflex (AVOR) in subjects with Meniere’s disease.

Vestibular nerve section in a child with intractable Menière's disease

Clinical presentation of Menière's disease in children is not as typical as in adults. The triad of vertigo, tinnitus and deafness are not usually elicited, diagnosis often being made after years of follow up and batteries of investigation. A case of Menière's disease in a 3-year-old boy is presented. The diagnosis was only obvious at the age of 8 when the triad of vertigo, deafness and tinnitus were present. His disease progressed despite a trial of intratympanic gentamicin injections and endolymphatic sac decompression. Vestibular nerve section was subsequently performed for his intractable disease. Following the procedure he was asymptomatic and able to attend school.

Translational Vestibulo‐Ocular Reflex Evoked by a “Head Heave” Stimulus

The gain and symmetry of vestibulo-ocular reflexes for high-frequency, high-acceleration movements of the head are altered following unilateral vestibular lesions. These changes have been well characterized for rotational head movements (thrusts), and provide reliable markers of dysfunction in individual semicircular canals. Alterations in the vestibulo-ocular reflex (VOR) evoked by lateral, whole-body translations have also been observed. In an approach directed at the development of a bedside test of otolith function, we have recorded (scleral search coil) the VOR evoked by brief, high-acceleration lateral translations (heaves). We delivered these stimuli manually and also developed a "head sled" device that minimizes any rotational contaminating component of the stimulus. Our geometrical analysis of the stimuli enables us to take into account the translational and rotational components of the movement, and to calculate an ideal response required for stabilization of images on the fovea at different fixation distances. We observed a tracking response (visually assisted VOR) that was close to ideal for image stabilization when these methods were used to analyze responses to slow, low-amplitude lateral translations of the head. When applied to rapid, high-acceleration (0.5 g) translations, the VOR was found to be less than compensatory in subjects with normal vestibular function. In a patient with unilateral vestibular hypofunction following intratympanic gentamicin injections, both the rotational and the translational VOR were asymmetric. Responses for translations toward the treated side had lower gain than those for translations toward the normal side. These findings provide a basis for further development of this technique as a clinical test and as a method for quantitative evaluation of otolith function.

Patients' subjective evaluations of quality of life related to disease-specific symptoms, sense of coherence, and treatment in Ménière's disease.

To evaluate the self-rated quality of life associated with vertigo, hearing loss, and tinnitus in Ménière's patients, and to identify potential relationships between these findings, treatment regimens, and sense of coherence in comparison to the classification of the American Academy of Otolaryngology-Head and Neck Surgery (AAO/HNS). Cross-sectional. Tertiary referral hospital centers. 112 patients with Méniére's disease, who had undergone endolymphatic sac surgery or intratympanic gentamicin injections, or were surgically untreated. Questionnaires concerning quality of life aspects and symptom-specific instruments: the Vertigo Symptom Scale (VSS), the Hearing Disability Handicap scale (HDHS), the Tinnitus Severity Questionnaire (TSQ), the AAO/HNS criteria for reporting results of treatment of Ménière's disease, and the Sense of Coherence Scale. A majority of the patients reported their quality of life in general as very good or good. There was no difference in general quality of life, present hearing loss, or tinnitus between the three treatment groups, but the gentamicin-treated patients had less vertigo than did the other groups. Sense of coherence showed a strong correlation to reported quality of life in all measurements. Even though the gentamicin-treated patients had less vertigo, no difference in overall quality of life was found between the surgically treated and untreated patients. The sense of coherence seems to be an important factor in the patient's experience of quality of life. Quality of life instruments can measure both specific symptoms and related aspects on quality of life and may give complementary information to the AAO/HNS classification in evaluating the treatment of patients with Ménière's disease.