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Time course of repeated intratympanic gentamicin for Ménière's disease
Kimanh D Nguyen1, Lloyd B Minor, Charles C Della Santina
1Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287-0910, USA.
Objectives/Hypothesis:
With low-dose and titration protocols, subsequent intratympanic (IT) gentamicin injections are frequently necessary for vertigo control in Ménière's disease. To date, studies have not provided detailed descriptions of the time course of recurrent vertigo and repeated injections. Our objective is to provide such a description with a Kaplan-Meier survival analysis, which may enable accurate predictions of the probability of recurrent vertigo after a given time or number of injections.
Study Design:
Injections of IT gentamicin were administered for unilateral definite Ménière's disease. One injection (or rarely more) in a 6-week period constituted a "round." Repeat rounds were given when needed for control of recurrent vertigo.
Methods:
We used a Kaplan-Meier method to quantify percentages of patients with control of vertigo over an 8-year period. A separate curve was created for each number of rounds, and failure for each was defined as the need for an additional round.
Results:
Of 78 patients, 75 (96%) achieved sufficient vertigo control to avoid ablative surgery, and 42 (54%) required only one round. Thirty-six (46%) required multiple rounds. The probability of needing another round increased with each subsequent one, through four rounds. The median times to the next round after one, two, or three rounds were 148, 118, and 124 days, respectively.
Conclusions:
More than half of patients need only one round of IT gentamicin injections. With each additional round through the fourth one, the probability of additional rounds increases. Nevertheless, the majority (96%) of patients do not need ablative surgery after IT gentamicin.
Insights
Intratympanic gentamicin injections effectively control Ménière
Area of Science:
- Otolaryngology
- Neurology
Background:
- Ménière's disease management often requires repeated intratympanic (IT) gentamicin injections for vertigo control.
- Detailed understanding of the time course for recurrent vertigo and subsequent injections is lacking.
Purpose of the Study:
- To describe the time course of vertigo recurrence and repeated IT gentamicin injections.
- To predict the probability of vertigo recurrence after specific times or numbers of injections using Kaplan-Meier analysis.
Main Methods:
- Kaplan-Meier survival analysis was used to quantify vertigo control over 8 years in patients with unilateral Ménière's disease receiving IT gentamicin.
- Separate curves were generated for each injection round, with 'failure' defined as requiring an additional round.
Main Results:
- Of 78 patients, 96% achieved vertigo control without ablative surgery.
- 54% required only one round of IT gentamicin; 46% needed multiple rounds.
- The likelihood of requiring additional rounds increased with each subsequent injection up to four rounds.
Conclusions:
- Over half of Ménière's disease patients achieve vertigo control with a single round of IT gentamicin.
- While the need for further rounds increases with each injection, most patients avoid ablative surgery.
- Kaplan-Meier analysis provides a tool for predicting recurrence probability and guiding treatment decisions.
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