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Intratympanic gentamicin as a treatment for drop attacks in patients with Meniere's disease
Lucas M Viana1, Fayez Bahmad, Steven D Rauch
1Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A; Faculty of Health Sciences, University of Brasilia, Brasilia, Distrito Federal, Brazil.
Objectives/Hypothesis:
Vertigo attacks in most cases of Meniere's disease (MD) are successfully treated with lifestyle changes and medication. However, approximately 6% of patients with MD develop drop attacks (DAs), a potentially life-threatening condition. Traditional treatment for DAs has been surgical labyrinthectomy. The objective of this study was to assess the effectiveness of intratympanic gentamicin for DAs in patients with MD.
Study Design:
Retrospective charts review.
Methods:
All charts were reviewed from Meniere DA patients at our hospital during the 10-year period from 2002 to 2012 who had been treated with intratympanic gentamicin and had been followed for at least 1 year afterward.
Results:
Twenty-four ears fulfilled inclusion criteria. The time for manifestation of DAs varied from 1 to 20 years after diagnosis (mean 10 years). A total of 83.3% of ears with intractable MD and DA achieved complete symptom control of DAs after the first intratympanic gentamicin cycle and 95.8% after the further injections. Among patients with no DA recurrence by the end of the study follow-up, the symptom-free interval varied from 12 to 120 months (mean: 43.5 months). All 15 patients with ≥ 24 months follow-up were still free of DAs. Elevated or absent vestibular evoked myogenic potential thresholds were more common in DA than in contralateral ears, and hearing loss was not a major complication of the treatment.
Conclusion:
Intratympanic gentamicin treatment appears to be a long-lasting and effective treatment for MD with DAs.
Insights
Intratympanic gentamicin effectively treats drop attacks (DAs) in Meniere
Area of Science:
- Otolaryngology
- Neurology
- Vestibular Disorders
Background:
- Meniere's disease (MD) often causes vertigo, but some patients develop severe drop attacks (DAs).
- DAs in MD are potentially life-threatening and traditionally treated with surgery.
- Intratympanic gentamicin offers a less invasive alternative for managing DAs.
Purpose of the Study:
- To evaluate the efficacy of intratympanic gentamicin for treating drop attacks in Meniere's disease.
- To assess the long-term effectiveness and safety of this treatment modality.
Main Methods:
- Retrospective chart review of Meniere's disease patients with drop attacks treated with intratympanic gentamicin.
- Inclusion criteria required treatment with intratympanic gentamicin and at least 1 year of follow-up.
- Data analysis focused on symptom control, recurrence rates, and complications.
Main Results:
- 83.3% of patients achieved complete DA symptom control after the first gentamicin cycle, with 95.8% after further injections.
- No DA recurrence was observed in patients with at least 24 months of follow-up.
- Hearing loss was not a significant complication, and vestibular evoked myogenic potential thresholds indicated treatment effects.
Conclusions:
- Intratympanic gentamicin is a long-lasting and effective treatment for drop attacks in Meniere's disease.
- This treatment provides significant symptom relief and a prolonged symptom-free interval.
- It represents a valuable therapeutic option for intractable Meniere's disease with drop attacks.
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