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Efficacy of increased gentamicin concentration for intratympanic injection therapy in Ménière's disease
Ashraf Saad Abou-Halawa1, Dennis S Poe
1Faculty of Medicine, Suez Canal University, Ismailia, Egypt.
Objectives:
Update of ongoing case series of intratympanic gentamicin use in intractable Ménière's disease. Comparison of the treatment results of two gentamicin concentrations: 30 mg/ml and 40 mg/ml.
Study Design:
Retrospective case-matched review of an ongoing protocol.
Setting:
Ambulatory visits in an office setting.
Patients:
Eighty-seven patients were included in this study according to the 1995 guidelines of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) for reporting treatment results of Ménière's disease.
Intervention:
Intratympanic injection of a buffered gentamicin solution (30 mg/ml) was used in 44 patients (Group 1) in years 1992 to 1995. Stock gentamicin solution (40 mg/ml) was used in 43 patients (Group 2) in years 1996 to 1999. Treatment was titrated for each patient, and the hearing was strictly monitored. The endpoint of treatment was the complete cessation of vertigo spells.
Main Outcome Measures:
Hearing results, vertigo control scores, and ice water caloric testing responses were analyzed after 24 months of follow-up. Thirty-two patients from each group were selected for case-matched statistical analysis.
Results:
Four or fewer gentamicin injections were used in 70% of Group 1 patients and 96% of Group 2 patients. In Group 1, vertigo control was achieved in 81% of patients, and the hearing remained the same or was improved in 68% of patients. In Group 2, vertigo control was achieved in 72% of patients, and the hearing remained the same or was improved in 81% of patients. Treatment was aborted in four patients of Group 2 for early reversible hearing loss, and 31 of 39 patients (79%) who completed the protocol experienced lasting vertigo control. There was a trend for longer-lasting vertigo control in the Group 2 patients.
Conclusion:
It was concluded that increasing the gentamicin concentration to 40 mg/ml probably produces similar rates of vertigo control as those of the lower dose, at least initially, but requires fewer injections. The higher dose did not increase the risk of hearing loss if treatment was stopped at the first indication of injury. A larger study is needed to confirm the trend of improved long-term hearing results in patients treated with the 40 mg/ml solution.
Insights
Higher concentration intratympanic gentamicin (40 mg/ml) for Ménière
Area of Science:
- Otolaryngology
- Neurotology
- Pharmacology
Background:
- Ménière's disease is a chronic inner ear disorder characterized by vertigo, tinnitus, and hearing loss.
- Intratympanic gentamicin injections are a common treatment for intractable Ménière's disease, aiming to reduce vestibular function.
Purpose of the Study:
- To compare the efficacy and safety of two different concentrations of intratympanic gentamicin (30 mg/ml vs. 40 mg/ml) for treating Ménière's disease.
- To evaluate the impact of gentamicin concentration on vertigo control, hearing preservation, and treatment duration.
Main Methods:
- A retrospective case-matched review of 87 patients with intractable Ménière's disease treated with intratympanic gentamicin.
- Patients received either 30 mg/ml (Group 1) or 40 mg/ml (Group 2) gentamicin, with treatment titrated and hearing monitored.
- Outcomes assessed included vertigo control, hearing results, and caloric testing responses after 24 months.
Main Results:
- The 40 mg/ml group required fewer injections (96% vs. 70% received ≤4 injections) for vertigo control.
- Vertigo control rates were 81% for 30 mg/ml and 72% for 40 mg/ml, with hearing preservation rates of 68% and 81%, respectively.
- The higher dose showed a trend towards longer-lasting vertigo control and did not increase hearing loss risk when treatment was carefully managed.
Conclusions:
- Increasing intratympanic gentamicin concentration to 40 mg/ml may offer similar initial vertigo control with fewer injections compared to 30 mg/ml.
- The higher concentration did not elevate hearing loss risk when treatment was judiciously applied.
- Further research is warranted to confirm potential long-term hearing benefits of the 40 mg/ml concentration.
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