Alfonso Scarpa1, Massimo Ralli2, Claudia Cassandro3, Federico Maria Gioacchini4, Matteo Alicandri-Ciufelli5, Pasquale Viola6, Giuseppe Chiarella6, Marco de Vincentiis7, Ettore Cassandro1. 1. Department of Medicine and Surgery, University of Salerno, Salerno, Italy. 2. Department of Sense Organs, Sapienza University Rome, Rome, Italy; Center for Hearing and Deafness, University at Buffalo, Buffalo, NY 14214, USA. Electronic address: massimo.ralli@uniroma1.it. 3. Surgical Sciences Department, University of Turin, Turin, Italy. 4. ENT Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy. 5. Otolaryngology Department, University Hospital of Modena, Modena, Italy. 6. Unit of Audiology, Regional Centre for Cochlear Implants and ENT Diseases, Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy. 7. Department of Sense Organs, Sapienza University Rome, Rome, Italy.
Abstract
PURPOSE: There are many therapeutic options for Meniere's disease (MD); intratympanic (IT) gentamicin has been proposed for intractable cases although controversy about dosage and method exists. The purpose of this study was to assess the efficacy and safety of low-dose IT gentamicin on vertigo attacks in MD using a clinical symptomatology-based method in which administration was repeated only if vertigo attacks recurred, with a 2-week interval between injections. MATERIALS AND METHODS: Forty-eight patients with unilateral intractable MD were included in the study. All patients received one to five IT injections with 0.5 ml of 10 mg of gentamicin (80 mg/2 ml) with an interval of 2 weeks between injections. Vertigo attacks were evaluated before and after therapy and categorized into classes A-F according to the 2015 Equilibrium Committee criteria. Audiovestibular assessment with pure tone audiometry, vestibular bed-side examination and video head impulse test was performed. RESULTS: Before treatment patients had an average of 4.4 vertigo attacks/month; after treatment the average number decreased to 0.52. The majority of patients (77%) reached Class A vertigo control with 5 or less gentamicin injections. VOR gain was unaffected in the healthy side and significantly reduced in the affected side. No hearing deterioration was found in all treated patients. CONCLUSIONS: Low-dose IT gentamicin administration based on clinical symptomatology can produce a satisfactory control of vertigo attacks after treatment; such protocol had an effect mainly on the vestibular function as demonstrated by the significant reduction in VOR gain in the affected side avoiding a cochlear damage.
PURPOSE: There are many therapeutic options for Meniere's disease (MD); intratympanic (IT) gentamicin has been proposed for intractable cases although controversy about dosage and method exists. The purpose of this study was to assess the efficacy and safety of low-dose IT gentamicin on vertigo attacks in MD using a clinical symptomatology-based method in which administration was repeated only if vertigo attacks recurred, with a 2-week interval between injections. MATERIALS AND METHODS: Forty-eight patients with unilateral intractable MD were included in the study. All patients received one to five IT injections with 0.5 ml of 10 mg of gentamicin (80 mg/2 ml) with an interval of 2 weeks between injections. Vertigo attacks were evaluated before and after therapy and categorized into classes A-F according to the 2015 Equilibrium Committee criteria. Audiovestibular assessment with pure tone audiometry, vestibular bed-side examination and video head impulse test was performed. RESULTS: Before treatment patients had an average of 4.4 vertigo attacks/month; after treatment the average number decreased to 0.52. The majority of patients (77%) reached Class A vertigo control with 5 or less gentamicin injections. VOR gain was unaffected in the healthy side and significantly reduced in the affected side. No hearing deterioration was found in all treated patients. CONCLUSIONS: Low-dose IT gentamicin administration based on clinical symptomatology can produce a satisfactory control of vertigo attacks after treatment; such protocol had an effect mainly on the vestibular function as demonstrated by the significant reduction in VOR gain in the affected side avoiding a cochlear damage.
Authors: Alfonso Scarpa; Massimo Ralli; Claudia Cassandro; Federico Maria Gioacchini; Antonio Greco; Arianna Di Stadio; Matteo Cavaliere; Donato Troisi; Marco de Vincentiis; Ettore Cassandro Journal: J Int Adv Otol Date: 2020-04 Impact factor: 1.017
Authors: P Viola; A Scarpa; D Pisani; C Petrolo; T Aragona; L Spadera; P De Luca; F M Gioacchini; M Ralli; E Cassandro; C Cassandro; G Chiarella Journal: Transl Med UniSa Date: 2020-05-31
Authors: C Cassandro; A Manassero; A Scarpa; V Landi; G Aschero; S Lovallo; P Velardo; P De Luca; A Albera; R Albera; E Cassandro Journal: Transl Med UniSa Date: 2019-01-12
Authors: C Cassandro; P De Luca; M Ralli; F Gioacchini; F Di Berardino; A Albera; R Albera; E Cassandro; A Scarpa Journal: Transl Med UniSa Date: 2019-01-12
Authors: A Scarpa; F M Gioacchini; E Cassandro; M Tulli; M Ralli; M Re; C Cassandro Journal: Acta Otorhinolaryngol Ital Date: 2019-10 Impact factor: 2.124