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Transtympanic gentamicin treatment using Silverstein MicroWick in Ménière's disease patients: long term outcome
R Suryanarayanan1, V R Srinivasan, G O'Sullivan
1Department of Otolaryngology, Arrowe Park Hospital, Wirral, Merseyside, UK.
Objective:
To assess the long term outcome of gentamicin inner-ear perfusion using the Silverstein MicroWick in the treatment of Ménière's disease.
Study Design:
Retrospective questionnaire survey of patients and review of medical records.
Setting:
A district general hospital.
Participants:
All 15 patients who completed a minimum follow up of at least 24 months were included.
Main Outcome Measures:
Subjective symptoms, change in hearing thresholds and Glasgow benefit inventory scores.
Results:
Based on the American Association of Otolaryngology-Head and Neck Surgery (1995) guidelines for reporting, 80 per cent of respondents obtained class A vertigo control and 20 per cent obtained class B control. Respondents' functional level improved from pre-operative levels of between three and six to post-operative levels of between one and three. Three respondents had pre-operative 'dead ears' and one developed the condition post-operatively. Hearing deteriorated further in three respondents, improved in two and remained unchanged in the rest. Respondents with class A control demonstrated improved quality of life, with a mean Glasgow benefit inventory total score of +34.
Conclusion:
Transtympanic gentamicin therapy via the Silverstein MicroWick results in good vertigo control. Patients should however be made fully aware of the risk of hearing deterioration.
Insights
Transtympanic gentamicin perfusion effectively controls vertigo in Ménière's disease patients, with most achieving excellent results. However, patients must be informed about the potential risk of hearing loss.
Area of Science:
- Otolaryngology
- Neurosurgery
- Audiology
Background:
- Ménière's disease is a chronic inner ear disorder characterized by vertigo, tinnitus, and hearing loss.
- Current treatments aim to manage symptoms and improve quality of life.
Purpose of the Study:
- To evaluate the long-term effectiveness of gentamicin inner-ear perfusion using the Silverstein MicroWick for Ménière's disease.
- To assess vertigo control, hearing changes, and functional outcomes.
Main Methods:
- Retrospective study involving 15 patients with Ménière's disease.
- Follow-up of at least 24 months.
- Data collected via questionnaires and medical records, assessing vertigo, hearing thresholds, and quality of life (Glasgow Benefit Inventory).
Main Results:
- 80% of patients achieved Class A vertigo control, and 20% achieved Class B control.
- Significant improvement in functional levels and quality of life (mean Glasgow Benefit Inventory score of +34 for Class A).
- Hearing deterioration occurred in some patients; however, improvement was noted in others.
Conclusions:
- Gentamicin inner-ear perfusion via Silverstein MicroWick offers effective vertigo control for Ménière's disease.
- The risk of hearing deterioration must be clearly communicated to patients undergoing this treatment.
