Jie Yang1,2,3, Huan Jia1,2,3, Gen Li1,2,3, Meiping Huang1,2,3, Weidong Zhu1,2,3, Zhaoyan Wang1,2,3, Yun Li1,2,3, Hao Wu1,2,3. 1. Department of Otolaryngology Head and Neck Surgery, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University. 2. Ear Institute, Shanghai Jiaotong University School of Medicine. 3. Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China.
Abstract
OBJECTIVE: To evaluate the objective and subjective effects of intratympanic gentamicin treatment in patients with small vestibular schwannomas who exhibit intractable vertigo. PATIENTS: Individuals diagnosed with small vestibular schwannomas who exhibited intractable vertigo were retrospectively reviewed. INTERVENTIONS: Intratympanic gentamicin injection. MAIN OUTCOME MEASURES: Vertigo control. RESULTS: Eight patients were included in the study. All patients achieved complete or substantial control of vertigo attacks while six patients reported residual imbalance. Three patients experienced significant hearing loss during therapy and follow-up. Only one patient showed a drop from Class B to Class C. Caloric tests and vestibular evoked myogenic potentials showed that all patients exhibited impaired peripheral vestibular function before treatment and that unilateral vestibular deafferentation was achieved during follow-up. Dizziness Handicap Inventory scores decreased over time, indicating an increase in the quality of life. CONCLUSIONS: Intratympanic gentamicin could provide an efficient approach to control intractable vertigo caused by small vestibular schwannoma. Before treatment, a complete physical examination, hearing level evaluation, vestibular function evaluation, and appropriate patient expectations are indispensable.
OBJECTIVE: To evaluate the objective and subjective effects of intratympanic gentamicin treatment in patients with small vestibular schwannomas who exhibit intractable vertigo. PATIENTS: Individuals diagnosed with small vestibular schwannomas who exhibited intractable vertigo were retrospectively reviewed. INTERVENTIONS: Intratympanic gentamicin injection. MAIN OUTCOME MEASURES: Vertigo control. RESULTS: Eight patients were included in the study. All patients achieved complete or substantial control of vertigo attacks while six patients reported residual imbalance. Three patients experienced significant hearing loss during therapy and follow-up. Only one patient showed a drop from Class B to Class C. Caloric tests and vestibular evoked myogenic potentials showed that all patients exhibited impaired peripheral vestibular function before treatment and that unilateral vestibular deafferentation was achieved during follow-up. Dizziness Handicap Inventory scores decreased over time, indicating an increase in the quality of life. CONCLUSIONS: Intratympanic gentamicin could provide an efficient approach to control intractable vertigo caused by small vestibular schwannoma. Before treatment, a complete physical examination, hearing level evaluation, vestibular function evaluation, and appropriate patient expectations are indispensable.
Authors: Alexander A Tarnutzer; Christopher J Bockisch; Elena Buffone; Alexander M Huber; Vincent G Wettstein; Konrad P Weber Journal: Front Neurol Date: 2021-02-09 Impact factor: 4.003