Intratympanic Gentamicin Treatment Research Articles

Efficacy and Durability of Intratympanic Gentamicin Treatment for Meniere's Disease.

Objective: To study the success of intratympanic gentamicin (ITG) treatment in reducing vertigo attacks in Meniere's disease (MD) and the value of the Halmagyi head thrust test (HTT) in predicting treatment durability.Study Design: Retrospective cohort study.Setting: Tertiary care vestibular clinic.Patients: Unilateral MD patients treated with ITG from 2006–2019 with ≥6 months follow-up.Main Outcome Measures: Demographics, audiometric data, subjective symptomatology, and HTT results were collected. Treatment success was defined as sufficient symptom relief. Treatment failure indicated vertigo control of less than 6 months duration. Treatment relapse indicated vertigo recurrence after 6 months.Results: Of 255 patients, treatment success, failure, and relapse occurred in 226 (88.6%), 29 (11.4%), and 121 (47.1%) patients, respectively. 48 (18.8%) patients who failed to respond or relapsed underwent labyrinthectomy. Mean follow-up time was 3.7 yrs (range 0.5–12.8). After ITG treatment, 25% patients reported worse hearing; mean pure tone average (PTA) increased by 18.6 ± 11.3 dB and mean word recognition score (WRS) decreased by 33 ± 21%. Of the 148 patients with negative pre-treatment HHT, 103 (69.6%) converted to positive after ITG treatment. Mean time-to-relapse in the converted and non-converted HTT cohorts was significantly different (49.7 vs. 27.0 months, p = 0.009) even after adjusting for gender, age, laterality, duration of symptoms, and number of ITG treatments. There were no significant differences between the two groups in hearing outcomes or subjective symptoms (e.g. lingering disequilibrium).Conclusions: ITG treatment effectively reduces the number of vertigo attacks in MD. HTT is valuable in predicting durability of treatment benefit.

Intratympanic gentamicin injection for refractory ménière's disease (MD) has potential effect in preventing contralateral MD occurrence

Background Ménière's disease (MD), characterized by episodic vertigo attacks and fluctuating progressive hearing loss, is treated by low-dose intratympanic gentamicin (ITG) injections. Whether ITG causes hearing loss is controversial, and knowledge about its effects on the contralateral hearing and vestibular function is lacking. Aims/Objectives We aimed to evaluate the effect of ITG on bilateral auditory and otolith organ function in patients with unilateral refractory MD. Material and Methods The data of 30 patients was collected, including history, and pure tone audiometry and vestibular-evoked myogenic potentials (VEMPs) results before and one month after ITG treatment. Changes in vertigo were assessed at a two-year follow-up. Results One month after ITG injection, auditory thresholds between 125 Hz and 8 kHz on the injection side remained unchanged but have improved on the contralateral side at 125 Hz, 250 Hz, 1 kHz. The cervical and ocular VEMP solicitation rates on the injection side were lower than before the injection. Two years after treatment, vertigo was improved in 88.5% and complete controlled in 76.7% patients respectively. Conclusions and Significance The intractable vertigo of MD can be effectively controlled by ITG injection. This can improve the low and medium frequency hearing level in the contralateral ear, suggesting that it might help prevent contralateral MD occurrence.

The Clinical Outcomes After Intratympanic Gentamicin Injection to Treat Menière's Disease: A Meta-analysis.

In recent decades, intratympanic gentamicin (ITG) has increasingly been used to treat intractable Menière's disease (MD). We performed a meta-analysis of pooled clinical outcomes, exploring whether ITG was effective and safe. Cochrane Library database, Embase, and Medline. We searched scientific and medical databases to March 2018 for articles evaluating clinical outcomes after ITG treatment of intractable MD according to the American Academy of Otolaryngology Head and Neck Surgery (AAO-HNS) guidelines. We performed a meta-analysis to evaluate treatment efficacy and safety. Quantitative and descriptive information of included RCTs was obtained. We ultimately evaluated 49 of the initially retrieved 1,062 citations (the 49 articles included data from a total of 2,344 MD patients). In almost all studies, patients served as their own controls; "before-and-after" clinical outcomes were reported. The I metric was used to explore heterogeneity. Overall, our results seem to provide the limited evidence about efficacy and toxicity effects of ITG. However, clinical outcomes require further confirmation; many included studies were poorly designed, less than 2 years for reporting results in MD are in the majority of patients. More long-term prospective follow-up, high-quality, large-scale, randomized controlled trials are needed to confirm that ITG is safe and effective when used to treat intractable MD.

Clinical features and management of Meniere's disease patients with drop attacks.

The aims of the present study are to investigate the variations in clinical features, including medical history, hearing function, vestibular function, and degree of endolymphatic hydrops (EH), in Meniere's disease (MD) patients with and without drop attacks (DAs), and to examine the efficacy of intratympanic gentamicin (ITG) treatment in alleviating DAs. In total, 177 unilateral definite MD patients, including 16 patients with DAs and 161 patients without DAs, were enrolled. The results of hearing test, vestibular-evoked myogenic potentials (VEMPs), and magnetic resonance imaging (MRI) were analyzed. Thirteen patients with DAs received a single ITG treatment and were followed up. The disease course of MD in the DA group was significantly longer than that in the control group (p = 0.007). MD patients with DAs had significantly greater hearing loss and worse EH than MD patients without DAs (p < 0.05). However, there was no between-group difference in vestibular function. In the study, 92.31% of refractory definite MD patients with DAs achieved satisfactory control of DAs after ITG treatment. MD patients with DAs tend to suffer from severe hearing loss and a significant degree of EH in the inner ear. However, the vestibular function of MD patients with DAs may not be completely abolished, but be sensitive to stimulating signals. ITG treatment, which helps to decrease vestibular sensitivity, was an effective treatment to control DAs.

Intratympanic Gentamicin for Small Vestibular Schwannomas With Intractable Vertigo.

To evaluate the objective and subjective effects of intratympanic gentamicin treatment in patients with small vestibular schwannomas who exhibit intractable vertigo. Individuals diagnosed with small vestibular schwannomas who exhibited intractable vertigo were retrospectively reviewed. Intratympanic gentamicin injection. Vertigo control. Eight patients were included in the study. All patients achieved complete or substantial control of vertigo attacks while six patients reported residual imbalance. Three patients experienced significant hearing loss during therapy and follow-up. Only one patient showed a drop from Class B to Class C. Caloric tests and vestibular evoked myogenic potentials showed that all patients exhibited impaired peripheral vestibular function before treatment and that unilateral vestibular deafferentation was achieved during follow-up. Dizziness Handicap Inventory scores decreased over time, indicating an increase in the quality of life. Intratympanic gentamicin could provide an efficient approach to control intractable vertigo caused by small vestibular schwannoma. Before treatment, a complete physical examination, hearing level evaluation, vestibular function evaluation, and appropriate patient expectations are indispensable.

Low Concentration Intra-Tympanic Gentamicin Treatment for Menière's Disease: A Long-Term Follow Up.

Intra-tympanic injections of gentamicin (ITG), a known ototoxic agent, have been proven to be effective in controlling Menière's disease (MD) symptoms, in patients who did not respond to conservative therapy, although its safety was questionable. To study whether low-concentration ITG, in refractory MD, had an effect on the ipsilateral hearing, in comparison to the contralateral ear, and to study the effectiveness of such treatment. A comparative, retrospective cohort study was conducted between 2003 and 2015, and compared the change in the hearing level between the injected ear and the contralateral, untreated ear. In 20 of 27 patients (74.1%), one course of ITG treatment was considered as successful. In the short-term, there was improvement of hearing level at 1000 Hz (p = 0.014), and deterioration of hearing level at 8000 Hz (p = 0.039), both in comparison to the control ear. In the long-term and after confounders adjustment, we found there were no differences in the hearing levels between the treated ear and the untreated contralateral ear. A high success rates of treating vertigo attacks with low concentration ITG in refractory unilateral MD patients is herein reported, while a significant difference was not observed in the hearing threshold compared with the healthy contralateral ear.

End-point indicators of low-dose intra-tympanic gentamicin in management of Ménière’s disease

Conclusions: One-shot, low-dose intra-tympanic gentamicin (ITG) treatment was effective and safe for Ménière’s disease (MD) patients. Head thrust test (HTT) and vestibular evoked myogenic potentials (VEMPs) test could be used as endpoint indicators for vertigo control in MD patients.Objectives: The present study is to explore end-point indicators of ITG injection in MD.Methods: Patients with MD were reviewed from June 2012 to March 2014. Single-shot ITG at a concentration of 30 mg/ml was administered to patients. The sensitivity and specificity of HTT and VEMPs for vertigo control were measured.Results: All 37 patients with a median follow-up of 26 months were included. Of those 37 patients, 24 patients (64.9%) obtained class A vertigo control and seven patients (18.9%) obtained class B vertigo control. Only six patients had class C control (16.2%). The sensitivity and specificity of HTT for vertigo control were 74.2% and 50.0%. Meanwhile, the sensitivity and specificity of VEMPs threshold were 83.9% and 33.3%. When combined HTT and VEMPs, sensitivity and specificity were 93.5% and 66.7%. Based on the four-tone average thresholds at 0.5, 1, 2, 3 kHz, 78.4% patients had no significant change in PTA and 16.2% patients experienced significant improvement.

Refractory episodic vertigo: role of intratympanic gentamicin and vestibular evoked myogenic potentials

IntroductionEven today, the treatment of intractable vertigo remains a challenge. Vestibular ablation with intratympanic gentamicin stands as a good alternative in the management of refractory vertigo patients. ObjectiveTo control intractable vertigo through complete saccular and horizontal canal vestibular ablation with intratympanic gentamicin treatment. MethodsPatients with refractory episodic vertigo were included. The inclusion criteria were: unilateral ear disease, moderate to profound sensorineural hearing loss, and failure to other treatments. Included patients underwent 0.5–0.8mL of gentamicin intratympanic application at a 30mg/mL concentration. Vestibular ablation was confirmed by the absence of response on cervical vestibular evoked myogenic potentials and no response on caloric tests. Audiometry, electronystagmography with iced water, and vestibular evoked myogenic potentials were performed in all patients. ResultsTen patients were included; nine patients with Meniere's disease and one patient with (late onset) delayed hydrops. Nine patients showed an absent response on vestibular evoked myogenic potentials and no response on caloric tests. The only patient with low amplitude on cervical vestibular evoked myogenic potentials had vertigo recurrence. Vertigo control was achieved in 90% of the patients. One patient developed hearing loss >30dB. ConclusionsCervical vestibular evoked myogenic potentials confirmed vestibular ablation in patients treated with intratympanic gentamicin. High-grade vertigo control was due to complete saccular and horizontal canal ablation (no response to iced water in electronystagmography and no response on cervical vestibular evoked myogenic potentials).

Histopathologic Changes of the Inner ear in Rhesus Monkeys After Intratympanic Gentamicin Injection and Vestibular Prosthesis Electrode Array Implantation.

Bilateral vestibular deficiency (BVD) due to gentamicin ototoxicity can significantly impact quality of life and result in large socioeconomic burdens. Restoring sensation of head rotation using an implantable multichannel vestibular prosthesis (MVP) is a promising treatment approach that has been tested in animals and humans. However, uncertainty remains regarding the histopathologic effects of gentamicin ototoxicity alone or in combination with electrode implantation. Understanding these histological changes is important because selective MVP-driven stimulation of semicircular canals (SCCs) depends on persistence of primary afferent innervation in each SCC crista despite both the primary cause of BVD (e.g., ototoxic injury) and surgical trauma associated with MVP implantation. Retraction of primary afferents out of the cristae and back toward Scarpa's ganglion would render spatially selective stimulation difficult to achieve and could limit utility of an MVP that relies on electrodes implanted in the lumen of each ampulla. We investigated histopathologic changes of the inner ear associated with intratympanic gentamicin (ITG) injection and/or MVP electrode array implantation in 11 temporal bones from six rhesus macaque monkeys. Hematoxylin and eosin-stained 10-μm temporal bone sections were examined under light microscopy for four treatment groups: normal (three ears), ITG-only (two ears), MVP-only (two ears), and ITG + MVP (four ears). We estimated vestibular hair cell (HC) surface densities for each sensory neuroepithelium and compared findings across end organs and treatment groups. In ITG-only, MVP-only, and ITG + MVP ears, we observed decreased but persistent ampullary nerve fibers of SCC cristae despite ITG treatment and/or MVP electrode implantation. ITG-only and ITG + MVP ears exhibited neuroepithelial thinning and loss of type I HCs in the cristae but little effect on the maculae. MVP-only and ITG + MVP ears exhibited no signs of trauma to the cochlea or otolith end organs except in a single case of saccular injury due to over-insertion of the posterior SCC electrode. While implanted electrodes reached to within 50-760 μm of the target cristae and were usually ensheathed in a thin fibrotic capsule, dense fibrotic reaction and osteoneogenesis were each observed in only one of six electrode tracts examined. Consistent with physiologic studies that have demonstrated directionally appropriate vestibulo-ocular reflex responses to MVP electrical stimulation years after implantation in these animals, histologic findings in the present study indicate that although intralabyrinthine MVP implantation causes some inner ear trauma, it can be accomplished without destroying the distal afferent fibers an MVP is designed to excite.

Total Vestibular Ablation and VEMPs after Intratympanic Gentamicine in Patients with Intractable Vertigo

Objectives: Even today, treatment of intractable vertigo remains a challenge. The objective of this study was to control intractable vertigo through complete vestibular ablation with intratympanic gentamicin treatment. Complete vestibular ablation was confirmed by zero response on ice water (ENG) and an absent response on vestibular evoked myogenic potentials (VEMPs). Methods: Retrospective case study design in a tertiary care center. Subjects were patients with refractory episodic vertigo. The inclusion criteria were unilateral ear disease, moderate to profound sensorineural hearing loss, and failure to respond to other treatments. Included patients underwent 0.5-0.8 mL of gentamicin intratympanic application at a 30 mg/mL concentration. Audiometry, electronystagmography with ice water, and vestibular evoked myogenic potentials were performed in all patients. Outcome measurements: VEMPs response and vertigo control. Results: Ten patients were included; 9 patients with Ménière’s disease and 1 patient with delayed endolymphatic hydrops. Nine patients showed an absent response on VEMPs. The only patient with low amplitude on VEMPs had vertigo recurrence. Vertigo control was achieved in 90% of the patients. One patient developed hearing loss &gt;30 dB. Conclusions: VEMPs confirmed complete vestibular ablation. High-grade vertigo control was due to total vestibular ablation.

Intratympanic gentamicin treatment for Ménière’s disease: a randomized, double-blind, placebo-controlled trial on dose efficacy - results of a prematurely ended study

BackgroundGentamicin is used as a therapeutic agent for Ménière’s disease because of its vestibulotoxicity causing chemo-ablation of the vestibular sensory epithelia. Its use has increased in recent years. However, there is still no consensus about the dose regimen of gentamicin in the treatment of Ménière’s disease. In this study two different dose regimen treatment protocols are compared in a placebo controlled study design. The primary objective is to quantify the treatment effect on dizziness, the secondary objective is hearing evaluation.MethodsWe performed a randomized, double-blind, placebo-controlled study in adults with unilateral Ménière’s disease according to the AAO-HNS guidelines resistant to conservative medication. Three groups received four injections, administered weekly (four intratympanic injections with 40 mg/mL gentamicin solution, two injections gentamicin solution and two injections of placebo in random order, or four injections with placebo). Outcome measures were the score on the Dizziness Handicap Inventory and pure tone audiometry (PTA). Intended follow-up was 2 years.ResultsDuring follow-up one patient exceeded the accepted amount of hearing loss. Further, enrollment was very slow (until 12 months between two patients) and new insights showed an apparent benefit of intratympanic gentamicin treatment (ITG). Therefore we performed an unscheduled interim analysis which showed that PTA threshold shifts reached the stopping criteria in two more patients. Because of this, this study was ended. Of the three patients with the significant PTA threshold shift two were enrolled in the gentamicin group.ConclusionNo conclusions can be drawn concerning doses regimens. Now that new publications have shown that ITG treatment can be an effective and safe treatment, a placebo-controlled randomized controlled trial may not pass the ethical committee because of these recent reports in literature. Still, a dose regimen study (without placebo) on ITG treatment needs to be performed.Trial registrationThis trial was registered in The University Medical Center Utrecht/ Gelre hospital Apeldoorn. Protocol ID: 07/343, EudraCT number 2006-005913-37.

Does Vestibular End-Organ Function Recover after Gentamicin-Induced Trauma in Guinea Pigs?

Until 1993 it was commonly accepted that regeneration of vestibular hair cells was not possible in mammals. Two histological studies then showed structural evidence for spontaneous regeneration of vestibular hair cells after gentamicin treatment. There is less evidence for functional recovery going along with this regenerative process; in other words, do regenerated hair cells function adequately? This study aims to address this question, and in general evaluates whether spontaneous functional recovery may occur, in the short or long term, in mammals after ototoxic insult. Guinea pigs were treated with gentamicin for 10 consecutive days at a daily dose of 125 mg/kg body weight. Survival times varied from 1 day to 16 weeks. Vestibular short-latency evoked potentials (VsEPs) to linear acceleration pulses were recorded longitudinally to assess otolith function. After the final functional measurements we performed immunofluorescence histology for hair cell counts. Auditory brainstem responses (ABRs) to click stimuli were recorded to assess cochlear function. As intended, gentamicin treatment resulted in significant loss of utricular hair cells and accompanying declines in VsEPs. Hair cell counts 8 or 16 weeks after treatment did not significantly differ from counts after shorter survival periods. Maximal functional loss was achieved 1-4 weeks after treatment. After this period, only 2 animals showed recovery of VsEP amplitude - all other animals did not reveal signs of regeneration or recovery. In contrast, after initial ABR threshold shifts there was a small but significant recovery. We conclude that spontaneous recovery of otolith function, in contrast to cochlear function, is very limited in guinea pigs. These results support the concept of intratympanic gentamicin treatment where gentamicin is used for chemoablation of the vestibular sensory epithelia.

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.

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.

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.

Magnetic Resonance Imaging Fails to Show Evidence of Reduced Endolymphatic Hydrops in Gentamicin Treatment of Ménière’s Disease

To verify the hypothesis that intratympanic (IT) gentamicin (Gent) treatment in Ménière's disease (MD) is capable of reducing endolymphatic hydrops (EH), as evaluated by 3-dimensional fluid-attenuated inversion recovery (3D-FLAIR) sequence in a 3-Tesla magnetic resonance imaging (MRI) unit, after IT gadolinium administration. A total of 8 patients (5 men and 3 women; aged 40-78 yr; median, 60 yr) with definite MD participated in the investigation. The duration of the disease ranged from 1 to 10 years (median, 4 yr), with a prevalence of vertigo spells of 1 to 6 per month (median, 3.1), as calculated in the last 6 months. A 3D-FLAIR MRI was performed 24 hours after IT injection of diluted gadobutrol. Intratympanic Gent injection was performed in a period variable from 1 to 3 weeks after 3D-FLAIR MRI. A single-shot administration protocol was attempted with additional injections administered on demand in the case of relapsing vertigo spells. MRI was repeated after 3 to 12 months (median, 8 mo) after treatment. The degree and extension of EH as evaluated by 3D-FLAIR MRI was compared from images obtained pre- and post-ITGent administration. After ITGent administration, 4 patients did not show any MRI modification, 3 patients showed a worsening of EH in one site, and 1 patient showed a worsening in two sites. No subjects presented reduction of EH. No evidence of reduced EH following ITGent treatment has been shown in the present imaging investigation.

Variability in the perilymphatic diffusion of gadolinium does not predict the outcome of intratympanic gentamicin in patients with ménière's disease

To assess the utility of imaging in planning intratympanic (IT) gentamicin (Gent) treatment in Ménière's disease (MD), we compared the dosage and outcomes of ITGent with the severity and extent of endolymphatic hydrops (EH), as evaluated by three-dimensional fluid-attenuated inversion recovery (3D-FLAIR) sequence in a 3-T magnetic resonance imaging (MRI) unit, after IT gadolinium administration. Retrospective review. A total of 18 patients (10 males and 8 females; age, 28-78 years; median age, 53.2 years) with definite MD participated in the investigation. The duration of the disease ranged from 8 months to 9 years (median, 2 years), with a prevalence of vertigo spells ranging from 0.8 to 8 per month (median, 2.2), as calculated in the last 6 months. A 3D-FLAIR MRI was performed 24 hours after IT injection of diluted gadobutrol. ITGent injection was performed within a variable period of time, from 1 week to 3 weeks after 3D-FLAIR MRI. The degree and extension of EH as evaluated by 3D-FLAIR MRI were compared with the number of injections necessary to cure vertigo attacks. Vertigo results, functional level scale modifications, variations in caloric excitability, and pure-tone average modifications. No statistically significant correlation was observed between severity of EH and outcomes of ITGent administration. The hypothesis of a reduced effect of Gent administered intratympanically in the presence of severe EH, owing to obstacled diffusion along the perilymphatic compartments, has not been confirmed in the present investigation.

Surgical management of common peripheral vestibular diseases

To review the latest developments in the surgical management of common peripheral vestibular disorders. Although surgery is indicated mainly for patients with Meniere's disease, other less common disorders such as benign paroxysmal positional vertigo, semicircular canal dehiscence, perilymphatic fistulae, fistulae of semicircular canals, VIII nerve vascular compression, chronic vestibular neuronitis, and dizziness following sudden sensorineural hearing loss may require surgical intervention when conservative management has failed. Surgery for vestibular disorders is less often indicated at present. Office-administered intratympanic gentamicin and steroid treatment have been found to be effective for control of vertigo in Meniere's disease. Side-effects of this treatment are overall acceptable. Surgery may be considered for Meniere's disease patients with good hearing who have failed intratympanic steroid treatment. Surgery is indicated for patients with debilitating dizziness associated with benign paroxysmal positional vertigo, semicircular canal dehiscence, vascular loop compression, and perilymphatic fistulae.

Single-shot, low-dose intratympanic gentamicin in Ménière disease: role of vestibular-evoked myogenic potentials and caloric test in the prediction of outcome

Objective The aim of this study was to assess the efficacy and safety of single and low-dose intratympanic gentamicin therapy in patients with Ménière disease and who were monitored both with caloric tests and vestibular-evoked myogenic potentials (VEMPs) to see if VEMPs have an additional role in predicting the efficacy of the drug. Study design This is a prospective cohort study. Setting Tertiary referral center is the study setting. Patients Twenty-five intractable Ménière disease patients were included as the study group. Intervention(s) Low-dose (16 mg/mL), single-shot intratympanic gentamicin was applied. VEMP and caloric test were applied 2 weeks after the application. Main outcome measure(s) Safety and efficacy of protocol were evaluated at the sixth month postoperatively with tonal audiogram and visual analog scale, respectively. Results Mean average pure-tone hearing threshold at 0.5, 1, 2, 4, and 8 kHz was 49.6 and 51.0 dB before and after the application, respectively ( P > .05). Mean pretreatment and posttreatment visual analog scale scores of patients were 17.6 mm (10–30 mm) and 74.6 mm (41–100 mm), respectively ( P < .01). Posttreatment VEMPs were absent in 17, deteriorated in 2, and not changed in 6 patients. VEMP was a significant predictor of posttreatment visual analog scale score, whereas caloric test was not ( P < .01). Conclusions Low-dose, single-shot intratympanic gentamicin treatment proved to be effective and safe among intractable Ménière patients. VEMPs obtained at posttreatment second week were significant predictors of patients posttreatment sixth-month dizziness status and vertigo control.