B E Hirsch1, D B Kamerer. 1. Department of Otolaryngology, University of Pittsburgh School of Medicine, Pennsylvania, U.S.A.
Abstract
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.
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.