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Round window gentamicin mu-catheter--a new therapeutic tool in Ménière's disease
1Department of Otorhinolaryngology, Head and Neck Surgery, Gentofte University Hospital, Denmark. Charabi@dadlnet.dk
Abstract:
The vestibulotoxic effect of gentamicin is well documented; however, there is no general agreement on the gentamicin dose needed to control vertigo attacks without affecting the hearing. In the current study, 14 patients with Ménière's disease refractory to medical treatment were treated by small doses of gentamicin delivered via a mu-catheter, placed into the round window niche. An electronic micropump delivered 10 microliters (100 micrograms)/h. The patients received a total dose of 4-14 mg. The effects on the vestibular symptoms were most encouraging, with cessation of vertigo in 13 of the 14 patients, control of Tumarkin attacks in 4 out of 6 cases and release of aural pressure and fullness in 2 out of 4 cases. According to the recommendations of the Committee on Hearing and Equilibrium, the patients in this material belonged to functional levels 5 and 6. At the last clinical follow-up, five patients were classified as level 1, eight patients as level 2 and one patient as level 3. A significant hearing loss was seen in one patient; however, this was most likely due to the natural development of the disease in this particular case. The results look promising, but must be investigated further in a placebo-controlled study.
Insights
Low-dose gentamicin treatment effectively controlled vertigo in Ménière
Area of Science:
- Otolaryngology
- Neurology
- Pharmacology
Background:
- Gentamicin's vestibulotoxic effects are known, but optimal dosing for vertigo control without hearing loss remains debated.
- Ménière's disease presents challenges in managing refractory vertigo and associated symptoms.
Purpose of the Study:
- To evaluate the efficacy and safety of low-dose gentamicin delivered via a mu-catheter for treating Ménière's disease.
- To determine if controlled gentamicin administration can alleviate vertigo without significant hearing impairment.
Main Methods:
- 14 patients with refractory Ménière's disease received low-dose gentamicin (4-14 mg total) via a mu-catheter into the round window niche.
- An electronic micropump delivered 10 microliters (100 micrograms) per hour.
- Patient outcomes were assessed using functional levels and symptom reporting.
Main Results:
- Vertigo ceased in 13 out of 14 patients.
- Tumarkin attacks were controlled in 4 of 6 cases; aural pressure/fullness improved in 2 of 4.
- Most patients improved from functional levels 5/6 to levels 1-3.
- Significant hearing loss occurred in only one patient, likely due to disease progression.
Conclusions:
- Low-dose, targeted gentamicin delivery shows promising results for controlling vertigo in Ménière's disease.
- This method appears to preserve hearing function in most treated patients.
- Further investigation with placebo-controlled studies is warranted to confirm these findings.