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Low Concentration Intra-Tympanic Gentamicin Treatment for Menière's Disease: A Long-Term Follow Up
Shlamkovitch Nathan1, Reut Lasry, Eviatar Ephraim
1Department of Otolaryngology Head and Neck Surgery, Assaf Harofeh Medical Center, Zerifin, Israel.
Background:
Intra-tympanic injections of gentamicin (ITG), a known ototoxic agent, have been proven to be effective in controlling Menière's disease (MD) symptoms, in patients who did not respond to conservative therapy, although its safety was questionable.
Objectives:
To study whether low-concentration ITG, in refractory MD, had an effect on the ipsilateral hearing, in comparison to the contralateral ear, and to study the effectiveness of such treatment.
Methods:
A comparative, retrospective cohort study was conducted between 2003 and 2015, and compared the change in the hearing level between the injected ear and the contralateral, untreated ear.
Outcomes:
In 20 of 27 patients (74.1%), one course of ITG treatment was considered as successful. In the short-term, there was improvement of hearing level at 1000 Hz (p = 0.014), and deterioration of hearing level at 8000 Hz (p = 0.039), both in comparison to the control ear. In the long-term and after confounders adjustment, we found there were no differences in the hearing levels between the treated ear and the untreated contralateral ear.
Conclusions:
A high success rates of treating vertigo attacks with low concentration ITG in refractory unilateral MD patients is herein reported, while a significant difference was not observed in the hearing threshold compared with the healthy contralateral ear.
Insights
Low-concentration intra-tympanic gentamicin injections effectively treat Meniere's disease (MD) vertigo. Long-term hearing levels in treated ears showed no significant difference compared to untreated ears, addressing safety concerns.
Area of Science:
- Otolaryngology
- Neurosurgery
- Pharmacology
Background:
- Intra-tympanic gentamicin injections (ITG) are used for Meniere's disease (MD) unresponsive to conservative therapy.
- ITG's ototoxic nature raises safety concerns regarding hearing preservation.
Purpose of the Study:
- To evaluate the effect of low-concentration ITG on ipsilateral hearing compared to the contralateral ear in refractory MD.
- To assess the effectiveness of low-concentration ITG treatment for Meniere's disease.
Main Methods:
- A retrospective cohort study (2003-2015) compared hearing changes in injected vs. untreated contralateral ears.
- Audiometric data was analyzed to assess short-term and long-term hearing threshold differences.
Main Results:
- Treatment success was observed in 74.1% of patients after one ITG course.
- Short-term hearing showed improvement at 1000 Hz and deterioration at 8000 Hz compared to the control ear.
- Long-term analysis, adjusted for confounders, revealed no significant hearing level difference between treated and untreated ears.
Conclusions:
- Low-concentration ITG demonstrates high success rates in managing vertigo for refractory unilateral MD.
- This treatment approach appears safe concerning long-term hearing thresholds when compared to the contralateral ear.