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Intratympanic gentamicin therapy for Ménière's disease
1Department of Otolaryngology, University of Pittsburgh School of Medicine, Pennsylvania, U.S.A.
Objective:
To evaluate the efficacy and toxicity of intratympanic gentamicin therapy for the treatment of Meniere's disease.
Study Design:
We compared retrospective case series with historical controls.
Setting:
A tertiary referral center--the ambulatory clinic at The University of Pittsburgh Medical Center.
Patients:
The study consisted of 28 patients with Meniere's disease who failed conventional medical therapy and were offered gentamicin treatment or surgical intervention. Patients had to be followed for at least 2 years to be eligible for review.
Intervention:
Intratympanic gentamicin solution injections were given by serial titration to the involved ear on a weekly or biweekly schedule.
Main Outcome Measures:
Adhering to the American Academy of Otolaryngology--Head and Neck Surgery 1985 criteria for reporting treatment results in Meniere's disease, the hearing status, control of vertigo, and disability scores using intratympanic gentamicin therapy were reported and compared with historical controls.
Results:
Complete or substantial control of vertigo was achieved in 91% of patients. Hearing loss occurred in approximately one third of patients. Historically, similar hearing loss occurs in patients who were treated successfully, either medically or surgically. Ototoxicity (high frequency hearing loss) was more likely to be seen in patients with pre-treatment 8,000 Hz hearing thresholds better than 65dB.
Conclusions:
Intratympanic gentamicin therapy given by serial titration injections provides significant control of vertigo without the significant cost and potential morbidity of a more invasive surgical procedure.
Insights
Intratympanic gentamicin therapy effectively controls Meniere's disease vertigo in 91% of patients. While hearing loss occurs in one-third, it is comparable to surgical outcomes, offering a less invasive treatment option.
Area of Science:
- Otolaryngology
- Neurology
- Pharmacology
Background:
- Meniere's disease is a chronic inner ear disorder characterized by vertigo, hearing loss, and tinnitus.
- Conventional medical therapies often fail to provide adequate symptom control for Meniere's disease.
- Surgical interventions carry significant risks and costs, necessitating exploration of alternative treatments.
Purpose of the Study:
- To assess the efficacy and toxicity of intratympanic gentamicin injections for Meniere's disease.
- To compare outcomes of gentamicin therapy with historical control data.
- To evaluate hearing status, vertigo control, and disability scores post-treatment.
Main Methods:
- Retrospective case series analysis of 28 Meniere's disease patients treated with serial titration of intratympanic gentamicin.
- Comparison with historical controls who received conventional medical or surgical treatment.
- Adherence to American Academy of Otolaryngology--Head and Neck Surgery 1985 criteria for outcome reporting.
Main Results:
- Significant vertigo control (complete or substantial) achieved in 91% of patients.
- Hearing loss observed in approximately one-third of patients, similar to historical treatment outcomes.
- Ototoxicity, specifically high-frequency hearing loss, was more prevalent in patients with better pre-treatment hearing thresholds.
Conclusions:
- Intratympanic gentamicin therapy offers a highly effective and less invasive method for managing Meniere's disease vertigo.
- This treatment provides substantial vertigo control with a lower risk profile compared to surgical options.
- Gentamicin therapy represents a valuable therapeutic strategy for patients refractory to conventional Meniere's disease treatments.