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[Intratympanic gentamicin treatment for intractable Menière's disease]
D Gilony1, M Wolf, J Kronenberg
1Departments of Otorhinolaryngology, Head & Neck Surgery, Chaim Sheba Medical Center, Tel Hashomer.
Background:
Intratympanic gentamicin is an accepted mode of treatment for patients with Meniere's disease who suffer from recurrent vertigo attacks in spite of conservative medical treatment. Recently, it gained popularity as the primary treatment for intractable Meniere's disease, prior to surgical procedures. However, administration methods and treatment protocols still differ from one medical center to another.
Objectives:
We aimed to present outcomes of gentamicin treatment for vertigo attacks and functional capacity, based on our experience with 23 patients over 3 years and review the literature on the subject.
Methods:
Three specially prepared gentamicin injections, were administered once a month, according to the state of vertigo attacks, functional capacity, and hearing status. Clinical observation, frequent hearing examinations and caloric tests were used for follow-up.
Results:
Following treatment, 20 (87%) patients no longer experienced vertigo attacks, while 16 of them (69.6%) reported full functional recovery. Two patients (8.7%) did not respond to treatment, and therefore, underwent surgical procedures. One patient (4.4%) did not complete therapy. Post treatment caloric tests showed significant deterioration (P < 0.02). Severe vestibular weakness (51-100%) was found in the treated ear in 11 of the 14 patients with unilateral disease (78.6%). The mean change in hearing examination was non-significant. However, two of the 21 patients suffered a change from moderate to severe hearing loss to complete deafness (9.5%). There was no case of post treatment infection or permanent tympanic perforation.
Conclusions:
Intratympanic gentamicin injection is a simple and safe procedure for intractable Meniere's patients, with a high success rate and low risk for hearing deterioration. It is recommended for patients with continuous functional disability prior to surgical treatment.
Insights
Intratympanic gentamicin injections effectively treat Meniere's disease vertigo attacks in 87% of patients, offering a safe, high-success alternative to surgery. This treatment provides significant functional recovery with minimal risk of hearing loss.
Area of Science:
- Otolaryngology
- Neurology
- Vestibular Disorders
Context:
- Meniere's disease often causes debilitating vertigo attacks.
- Intratympanic gentamicin is increasingly used for intractable cases.
- Treatment protocols vary across medical centers.
Purpose:
- To evaluate the efficacy of intratympanic gentamicin injections for vertigo control and functional recovery in Meniere's disease.
- To assess the safety profile, including hearing status and vestibular function.
- To review existing literature on gentamicin treatment for Meniere's disease.
Summary:
- A study of 23 patients with Meniere's disease treated with monthly intratympanic gentamicin injections.
- 87% of patients achieved vertigo control, and 69.6% reported full functional recovery.
- Significant vestibular weakness was observed post-treatment, but hearing deterioration was minimal, with no infections or perforations.
Impact:
- Intratympanic gentamicin offers a safe and effective treatment option for intractable Meniere's disease, reducing vertigo and improving function.
- The procedure has a high success rate and a low risk of hearing loss, making it a viable alternative to surgery.
- This approach can significantly improve the quality of life for patients suffering from chronic vertigo.
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