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Irritative spontaneous nystagmus following intratympanic gentamicin for Menière's disease
1Department of Otolaryngology, University of Western Ontario, London, Canada.
Abstract:
Intratympanic aminoglycosides were first used to treat unilateral intractable Meniere's disease over 30 years ago. Gentamicin, the current drug of choice, provides excellent vertigo control with a low incidence of hearing loss. Its salutory effect results from direct damage to both the sensory neuroepithelium and the dark cells of the labyrinth. This latter effect may reverse the degree of endolymphatic hydrops. Twelve patients with unilateral Meniere's disease were treated and prospectively studied. Although further follow-up is necessary, 10 patients have complete vertigo control, while 2 remain significantly improved. Three patients developed a spontaneous "irritative" nystagmus during the early post-treatment period. This new unique finding may represent a recovery phenomenon resulting from a temporary reversible ototoxic effect in the treatment ear. Despite our patients having a somewhat higher incidence of hearing loss compared to the reported rate, the results of this treatment are encouraging.
Insights
Intratympanic gentamicin offers effective vertigo control for Meniere's disease by damaging inner ear structures. Some patients experienced temporary nystagmus, possibly indicating a recovery response.
Area of Science:
- Otolaryngology
- Nephrology
- Neurology
Background:
- Intratympanic aminoglycosides, particularly gentamicin, have been utilized for over 30 years to manage unilateral intractable Meniere's disease.
- Gentamicin is the preferred agent, known for its efficacy in vertigo suppression and a generally low risk of hearing impairment.
Observation:
- This study prospectively evaluated twelve patients with unilateral Meniere's disease undergoing intratympanic gentamicin treatment.
- A unique observation was the development of spontaneous "irritative" nystagmus in three patients post-treatment, potentially signifying a reversible ototoxic recovery phenomenon.
Findings:
- Ten out of twelve patients achieved complete vertigo control, with the remaining two showing significant improvement.
- While a slightly higher incidence of hearing loss was noted compared to previous reports, the overall treatment outcomes were encouraging.
Implications:
- Intratympanic gentamicin remains a viable and effective therapeutic option for unilateral Meniere's disease.
- The observed nystagmus may offer insights into the inner ear's recovery mechanisms following ototoxic insult.
- Further long-term follow-up is warranted to fully ascertain the durability of treatment effects and the incidence of hearing loss.