Direct Round Window Membrane Application of Gentamicin in the Treatment of Meniere's Disease

Silverstein, Herbert; Arruda, Johnny; Rosenberg, Seth I.; Deems, Daniel A.; Hester, T. Oma

doi:10.1053/hn.1999.v120.a91763

Cited by 75 publications

(16 citation statements)

References 25 publications

(47 reference statements)

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“…A piece of gel foam soaked in gentamicin (26.7 mgr/mL) was put in front of the round window after cleaning this area, and vertigo control was reported as 75%, but hearing loss appeared in 10% of the patients [8] . On the opposite, the round window was protected with a piece of connective tissue, and then IT gentamicin (80 mg/mL) was administered twice a week [10] .…”

Section: Discussionmentioning

confidence: 99%

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Selective Window Application of Gentamicin Dexamethasone in Meniere's Disease

Ardıç

Tümkaya²,

Aykal³

et al. 2017

Int Adv Otol

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OBJECTIVE:The purpose of the study is to prevent hearing loss when using intratympanic (IT) gentamicin for intractable Meniere's disease. MATERIALS and METHODS:It is a retrospective case review study. Twenty five patients who had definite Meniere's disease and had either selective window application or weekly IT gentamicin were included into the study. First group (selective) had dexamethasone on the round window and gentamicin on oval window during exploratory tympanotomy procedure. The second group had IT gentamicin at weekly intervals. The degree of caloric weakness (CW), average hearing level in low pitch (HLP) (250, 500, 1000, 2000 Hz) and high pitch (HHP) (4000, 6000, 8000 Hz) were compared before and after treatment. The need for further treatment was noted. RESULTS:In the first group, the average HLP was increased from 51.6±7dB to 52.2±5.6 dB. The average HHP was increased 41.96±20.2 dB to 47.2±18.3 dB after treatment. The CW changed from 37.6±23.9 % to 54.6±30.6 %. In the second group, the average HLP was increased from 56.3±10.5 dB to 61.65±18.3 dB. The average HHP was increased 59.05±17.4 dB to 69.4±21.98 dB after treatment. The CW changed from 45.8±22.3% to 71.53±29.63 %. Both methods had statisticaly significant increase in caloric weakness. But only IT gentamicin led a significant hearing loss in HHP. CONCLUSION:The use of dexamethasone and gentamycin via different windows in the middle ear is safe and effective method for Meniere's disease in the short term. Application of dexamethasone protects not only the hearing cells but vestibular cells also.

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Section: Discussionmentioning

confidence: 99%

“…A piece of gelfoam soaked in gentamicin was directly put on the round window in order to standardize the dose and duration of the agent given [8] . Some others covered the round window with connective tissue, then administered IT gentamicin [9,10] .…”

Section: Introductionmentioning

confidence: 99%

Selective Window Application of Gentamicin Dexamethasone in Meniere's Disease

Ardıç

Tümkaya²,

Aykal³

et al. 2017

Int Adv Otol

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“…Vertigo was controlled in most of these patients (100% in Schuknecht's series; 88% in Lange's), but the rates of sensorineural hearing loss attributed to the aminoglycosides were unacceptably high (62% and 48%, respectively). Subsequent reductions in the number and frequency of doses have resulted in control of vertigo in 70%± 90% of patients and a reduction in the incidence of sensorineural hearing loss (Beck and Schmidt 1978;Odkvist et al 1984;Nedzelski et al 1992Nedzelski et al , 1993Toth and Parnes 1995;Murofushi et al 1997;Hirsch and Kamerer 1997;Rauch and Oas 1997;Minor 1999;Silverstein et al 1999;Atlas and Parnes 1999). Most recently, it has been shown that a single intratympanic injection of gentamicin is effective in the control of vertigo in most patients (Freedman and Sparks 1997).…”

Section: Introductionmentioning

confidence: 99%

Changes in the Three-Dimensional Angular Vestibulo-Ocular Reflex following Intratympanic Gentamicin for Ménière's Disease

Carey

Minor

Peng

et al. 2002

JARO - Journal of the Association for Research in Otolaryngolog

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The 3-dimensional angular vestibulo-ocular re¯exes (AVOR) elicited by rapid rotary head thrusts were studied in 17 subjects with unilateral Me Ânie Áre's disease before and 2±10 weeks after treatment with intratympanic gentamicin and in 13 subjects after surgical unilateral vestibular destruction (SUVD). Each head thrust was in the horizontal plane or in either diagonal plane of the vertical semicircular canals, so that each head thrust effectively stimulated only one pair of canals. The AVOR gains (eye velocity/head velocity during the 30 ms before peak head velocity) for the head thrusts exciting each individual canal were averaged and taken as a measure of the function of that canal. Prior to intratympanic gentamicin, gains for head thrusts that excited canals on the affected side were 0.91 0.20 (horizontal canal, HC), 0.78 0.20 (anterior canal, AC), and 0.83 0.10 (posterior canal, PC). The asymmetries between these gain values and those for head thrusts that excited the contralateral canals were <2%. In contrast, caloric asymmetries averaged 40% 32%. Intratympanic gentamicin resulted in decreased gains attributable to each canal on the treated side: 0.40 0.12 (HC), 0.35 0.14 (AC), 0.31 0.14 (PC) (p < 0.01). However, the gains attributable to contralateral canals dropped only slightly, resulting in marked asymmetries between gains for excitation of ipsilateral canals versus their contralateral mates: HC: 34% 12%, AC: 24% 25%, and PC: 42% 13%. There was no difference in the AVOR gain for excitation of the ipsilateral HC after gentamicin in patients who received a single intratympanic injection (0.39 0.11, n = 12) in comparison to those who received 2±3 injections (0.42 0.15, n = 5, p = 0.7). Gain decreases attributed to the gentamicintreated HC and AC were not as severe as those observed after SUVD. This ®nding suggests that intratympanic gentamicin causes a partial vestibular lesion that may involve preservation of spontaneous discharge and/or rotational sensitivity of afferents.

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“…Obstruction of the surface area of the round window membrane cannot be detected without perforation of the tympanic membrane. In humans, Silverstein et al [19] noted that the round window niche was completed obstructed by mucous membranes in 12% and partially obstructed in 17%, which would allow for varying absorption rates, although others have not found such rates of obstruction. Variable thickness of round window membrane might also exist and this might change the penetration volume of the drug into the perilymph.…”

Section: Discussionmentioning

confidence: 99%

“…To prevent both bilateral and complete vestibular ablation, the subablative titration administration was invented. Recently in unilateral Meniere's disease local application of gentamicin (GM), such as intratympanic injection [8,13,25] and round window membrane application [19], was identified as a potentially beneficial and less invasive treatment. Although many treatment protocols have been reported, efficacy has been identical, and no single technique of GM injection has demonstrated a significant medical advantage over the others [2].…”

Section: Introductionmentioning

confidence: 99%

Semiquantitative Vestibulotoxicity to Subablative and Ablative Treated Gerbil Cristae Using Gentamicin or Streptomycin

Yamamoto

Slepecky

Suzuki

et al. 2004

Acta Histochem. Cytochem

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Semiquantitative histological evaluation was performed on inner ears from Mongolian gerbils to study vestibular damages using ototoxic drugs. Comparisons were made between animals receiving five daily injections of gentamicin/gelfoam slurry, streptomycin/gelfoam slurry, saline/gelfoam slurry and noninjected controls. For gentamicin treated ears, when percent decrease of nuclei in sensory cell layer was compared, the damage to the sensory cells was significantly more severe in the posterior crista than in the superior and lateral crista from two of three gerbils. For streptomycin treated ears, when percent decrease of nuclei in sensory cell layer was compared, the damage to the posterior crista was similar to superior and lateral crista. These results indicate that our models are useful for detecting different vestibulotoxicity among three cristae.

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Direct Round Window Membrane Application of Gentamicin in the Treatment of Meniere's Disease

Cited by 75 publications

References 25 publications

Selective Window Application of Gentamicin Dexamethasone in Meniere's Disease

Selective Window Application of Gentamicin Dexamethasone in Meniere's Disease

Changes in the Three-Dimensional Angular Vestibulo-Ocular Reflex following Intratympanic Gentamicin for Ménière's Disease

Semiquantitative Vestibulotoxicity to Subablative and Ablative Treated Gerbil Cristae Using Gentamicin or Streptomycin

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