Management of intractable Ménière's disease after intratympanic injection of Gentamicin

Yoon Chan Rah, Jae J. Han, Jaehong Park, Byung Y. Choi, Ja Won Koo

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Objectives/Hypothesis 1) To evaluate the efficacy of, and problems with, intratympanic gentamicin injection (ITG) in medically intractable definite Ménière's disease (MD) and secondary endolymphatic hydrops (EH); and 2) to review the vestibular status and treatment options of intractable vertigo even after ITG. Study Design Retrospective case review and survey. Methods 780 patients with definite MD and secondary EH were enrolled. Long-term outcomes and problems of applied treatment options including ITG and exploratory tympanotomy and gentamicin application (ETG) were analyzed. Results Of the 780 patients, 95 patients received ITG. Class A and B control of vertigo was achieved in 85 (89.5%) patients; two patients were class C and eight patients were class F (ETG: 6; labyrinthectomy: 1; vestibular neurectomy: 1). Among seven patients who received ETG including 1 patient who skipped ITG due to chronic otitis media, five patients improved to class A, showing a 71.4% success rate; and labyrinthectomies were performed subsequently in the two remaining patients. Vertigo was controlled (class A) in all the patients who received labyrinthectomies (n = 4) or vestibular neurectomy (n = 1). Eight patients (8.4%) experienced more than 10 dB worsening, and two patients (2.1%) progressed to bilateral Ménière's disease. Conclusion ITG failed to control vertigo in 10.5% of cases. ETG may be a reasonable option to facilitate the delivery of gentamicin into the inner ear by direct application of gentamicin over the round window and the oval window. Labyrinthectomy and vestibular neurectomy still have roles in the era of ITG.

Original languageEnglish
Pages (from-to)972-978
Number of pages7
JournalLaryngoscope
Volume125
Issue number4
DOIs
Publication statusPublished - 2015 Apr 1
Externally publishedYes

Fingerprint

Gentamicins
Vertigo
Endolymphatic Hydrops
Intratympanic Injection
Otitis Media
Inner Ear
Retrospective Studies

Keywords

  • Gentamicin
  • intratympanic injection
  • Ménière's disease
  • vertigo

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

Management of intractable Ménière's disease after intratympanic injection of Gentamicin. / Rah, Yoon Chan; Han, Jae J.; Park, Jaehong; Choi, Byung Y.; Koo, Ja Won.

In: Laryngoscope, Vol. 125, No. 4, 01.04.2015, p. 972-978.

Research output: Contribution to journalArticle

Rah, Yoon Chan ; Han, Jae J. ; Park, Jaehong ; Choi, Byung Y. ; Koo, Ja Won. / Management of intractable Ménière's disease after intratympanic injection of Gentamicin. In: Laryngoscope. 2015 ; Vol. 125, No. 4. pp. 972-978.
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abstract = "Objectives/Hypothesis 1) To evaluate the efficacy of, and problems with, intratympanic gentamicin injection (ITG) in medically intractable definite M{\'e}ni{\`e}re's disease (MD) and secondary endolymphatic hydrops (EH); and 2) to review the vestibular status and treatment options of intractable vertigo even after ITG. Study Design Retrospective case review and survey. Methods 780 patients with definite MD and secondary EH were enrolled. Long-term outcomes and problems of applied treatment options including ITG and exploratory tympanotomy and gentamicin application (ETG) were analyzed. Results Of the 780 patients, 95 patients received ITG. Class A and B control of vertigo was achieved in 85 (89.5{\%}) patients; two patients were class C and eight patients were class F (ETG: 6; labyrinthectomy: 1; vestibular neurectomy: 1). Among seven patients who received ETG including 1 patient who skipped ITG due to chronic otitis media, five patients improved to class A, showing a 71.4{\%} success rate; and labyrinthectomies were performed subsequently in the two remaining patients. Vertigo was controlled (class A) in all the patients who received labyrinthectomies (n = 4) or vestibular neurectomy (n = 1). Eight patients (8.4{\%}) experienced more than 10 dB worsening, and two patients (2.1{\%}) progressed to bilateral M{\'e}ni{\`e}re's disease. Conclusion ITG failed to control vertigo in 10.5{\%} of cases. ETG may be a reasonable option to facilitate the delivery of gentamicin into the inner ear by direct application of gentamicin over the round window and the oval window. Labyrinthectomy and vestibular neurectomy still have roles in the era of ITG.",
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