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Vestibular and audiologic functions in gentamicin-treated Menière's disease
C Möller1, L M Odkvist, J Thell
1Boys Town National Institute, Omaha, Nebraska.
Abstract:
Fifteen patients with disabling Meniere's disease were treated with local intratympanic administration of gentamicin once daily. They had suffered from frequent attacks of vertigo and vomiting, the hearing in the affected ears was decreased permanently, and spontaneous nystagmus was observed. The number of treatment days ranged between 3 and 11. Follow-up time was 1 to 6 years. For evaluation of the treatment, audiologic and vestibular examinations were used, including the broad frequency-band rotatory test (0.4-4.5 Hz). Fourteen patients were free from vertigo after treatment. In 5 patients, there was an increased hearing loss, and in 10 it remained unchanged. Tinnitus and fullness sensations were diminished. After treatment, all ears were unresponsive to caloric stimulation. The clinical examination and rotatory testing in light with sinusoidal stimulation revealed good central compensation of the vestibular loss. However, with pseudorandomized oscillations in darkness, the broad frequency-band rotatory test quantified the loss of peripheral vestibular function and was able to detect the side of the lesion in eight of nine patients.
Insights
Intratympanic gentamicin effectively eliminated vertigo in most Meniere's disease patients. While hearing loss persisted in some, the treatment significantly reduced symptoms and vestibular function loss was quantifiable.
Area of Science:
- Otolaryngology
- Neurology
- Vestibular System Disorders
Background:
- Meniere's disease causes disabling vertigo, hearing loss, and tinnitus.
- Intratympanic gentamicin is a potential treatment for severe Meniere's disease.
Purpose of the Study:
- To evaluate the efficacy of intratympanic gentamicin in treating disabling Meniere's disease.
- To assess the impact of treatment on vertigo, hearing, tinnitus, and vestibular function.
Main Methods:
- Fifteen patients with Meniere's disease received daily intratympanic gentamicin.
- Treatment duration ranged from 3 to 11 days.
- Audiologic, vestibular, and rotatory tests were used for evaluation over 1-6 years.
Main Results:
- Fourteen of fifteen patients achieved complete vertigo relief.
- Hearing loss increased in 5 patients, remained unchanged in 10.
- Tinnitus and fullness sensations decreased; all ears became unresponsive to caloric stimulation.
- Rotatory testing confirmed central compensation but quantified peripheral vestibular loss.
Conclusions:
- Intratympanic gentamicin is highly effective in controlling vertigo in Meniere's disease.
- The treatment leads to significant vestibular function loss, detectable by specific rotatory tests.
- Further assessment is needed for long-term hearing outcomes and optimal treatment protocols.