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Preliminary Evidence for the Effects of Gentamicin on Vertical Semicircular Canals
Salman Khan1, Alexandra E Quimby2,3, Tiffany P Hwa2
1Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Introduction:
Gentamicin is a vestibulotoxic antibiotic often used in patients with Ménière's disease for its vestibular ablative effects. Gentamicin's effect on the horizontal semicircular canal does not always correlate with the degree of vertigo control achieved by patients; its effect on the vertical semicircular canals remains unknown. We sought to examine the effect of intratympanic gentamicin on vertical semicircular canal function in patients with Ménière's disease using video head impulse testing.
Methods:
A retrospective case series was carried out at a tertiary academic center. Patients with Ménière's disease who received ≥1 intratympanic gentamicin injection from 2019-2022 and had video head impulse testing performed were included. Outcomes of interest were vertical semicircular canal function following intratympanic gentamicin, correlations between vertical semicircular canal function and horizontal semicircular canal function, and residual symptoms following injection.
Results:
Ten patients met inclusion criteria. Twenty percent had abnormal V-SCC function prior to any injection and 40% following the first injection. There was an association between abnormal vertical and horizontal semicircular canal function following the first intratympanic gentamicin injection, though the relationship did not reach statistical significance (p = 0.058). While patients with abnormal vertical semicircular canal function following the first injection were less likely to report ongoing vertigo attacks, the relationship was not statistically significant (p = 0.260).
Conclusions:
Intratympanic gentamicin leads to changes in vertical semicircular canal function in at least a proportion of patients with Ménière's disease. Further study is required to better assess correlations between vertical semicircular canal function and symptom control following intratympanic gentamicin.
Insights
Intratympanic gentamicin alters vertical semicircular canal function in Ménière
Area of Science:
- Otolaryngology
- Neuroscience
- Vestibular System Research
Background:
- Ménière's disease is a disorder of the inner ear affecting balance and hearing.
- Intratympanic gentamicin is a common treatment for Ménière's disease, known for its vestibular ablative effects.
- The impact of gentamicin on vertical semicircular canals, crucial for balance, is not well understood.
Purpose of the Study:
- To investigate the effect of intratympanic gentamicin on vertical semicircular canal (V-SCC) function in Ménière's disease patients.
- To explore correlations between V-SCC function, horizontal semicircular canal (H-SCC) function, and symptom control post-treatment.
Main Methods:
- Retrospective case series of Ménière's disease patients receiving intratympanic gentamicin (2019-2022).
- Utilized video head impulse testing (vHIT) to assess V-SCC and H-SCC function.
- Analyzed changes in V-SCC function, correlations with H-SCC function, and residual vertigo symptoms.
Main Results:
- Ten patients were included; 20% had abnormal V-SCC function pre-injection.
- Following the first gentamicin injection, 40% of patients exhibited abnormal V-SCC function.
- A trend suggested an association between abnormal V-SCC and H-SCC function (p=0.058) and reduced vertigo (p=0.260), but not statistically significant.
Conclusions:
- Intratympanic gentamicin can alter V-SCC function in a subset of Ménière's disease patients.
- Further research is needed to clarify the relationship between V-SCC function and symptom management after gentamicin treatment.
