Intratympanic Gentamicin Therapy for Ménière’s Disease: A Meta-analysis

Chia, Stanley H.; Gamst, Anthony; Anderson, John P.; Harris, Jeffrey P.

doi:10.1097/00129492-200407000-00023

Cited by 171 publications

(160 citation statements)

References 21 publications

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“…The success of IT gentamicin has been examined in a number of series and summarized in several meta-analyses (1)(2)(3). Although vertigo control is achieved in more than 85% of the subjects in these series, hearing loss and posttreatment disequilibrium remain significant concerns.…”

mentioning

confidence: 99%

Longitudinal Results With Intratympanic Dexamethasone in the Treatment of Ménière's Disease

Boleas-Aguirre

Lin²,

Santina³

et al. 2008

Otology &Amp; Neurotology

106

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Objective-To assess patient satisfaction with vertigo control using intratympanic (IT) dexamethasone (12 mg/mL) for medically refractory unilateral Ménière's disease.Study Design-Retrospective study. Setting-Tertiary referral neurotology clinic.Patients-One hundred twenty-nine subjects diagnosed with unilateral Ménière's disease still having vertigo despite medical therapy. Intervention-IT dexamethasone injections as needed to control vertigo attacks.Main Outcome Measure-A Kaplan-Meier time-to-event method was used to determine the rate of "survival," meaning sufficient satisfaction with vertigo control that the subject did not wish to have subsequent ablative treatment. "Failure" was defined as poor control and the choice to proceed to ablative treatment.Results-Acceptable vertigo control ("survival") was achieved in 117 (91%) of 129 subjects. Vertigo control required only one dexamethasone injection in 48 (37%), 2 injections in 26 (20%), 3 injections in 18 (14%), and 4 injections in 10 (8%). More than 4 injections were needed in 15 subjects (21%). Of 12 failures (9%), 9 occurred within 6 months of the first IT dexamethasone injection. Follow-up data for 2 years were available for 96 subjects. Of these, 87 (91%) had vertigo control with IT dexamethasone, of whom 61 (70)% required no further injections after 2 years, 23 (26%) continued to receive IT dexamethasone injections, and 3 (3%) chose IT gentamicin treatment.Conclusion-IT dexamethasone injection therapy on an as-needed outpatient basis can provide vertigo control that is satisfactory in patients with Ménière's disease. The Kaplan-Meier method addresses the need for an outcome measure suited to repeated treatments and variable lengths of follow-up. However, due to the retrospective nature of this study, the presence of bias caused by loss of subjects from follow-up cannot be ruled out.

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mentioning

confidence: 99%

Longitudinal Results With Intratympanic Dexamethasone in the Treatment of Ménière's Disease

Boleas-Aguirre

Lin²,

Santina³

et al. 2008

Otology &Amp; Neurotology

106

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“…High rates of complete or substantial vertigo control (over 85%) are achieved in many studies concerning ITG treatments [11][12][13] . Ototoxicity, which was a threat with former treatments using higher doses and titration protocols, can still be encountered rarely due to the cumulative effect of gentamicin [1] , thus hindering its common use. Moreover, it has been shown that even a single dose of gentamicin may cause ototoxicity in some cases as a result of idiosyncrasy [14] .…”

Section: Discussionmentioning

confidence: 99%

“…In a recent meta-analysis on ITG injection protocols, Chia et al [1] reported that weekly gentamicin injection protocols led to a mild ototoxicity rate compared to other protocols; but even in that case, the incidence of ototoxicity was as high as 13.1%. However, severe ototoxicity up to 34.7% was reported with daily multiple injection protocols [1] .…”

Section: Discussionmentioning

confidence: 99%

“…However, severe ototoxicity up to 34.7% was reported with daily multiple injection protocols [1] . In another study in which gentamicin-soaked pledgets were placed in the round window niche, complete or substantial vertigo control was achieved in 88.5% of the patients, but varying degrees of significant hearing impairments occurred in 12 out of 24 patients (50%), including 4 total sensorineural hearing losses [13] .…”

Section: Discussionmentioning

confidence: 99%

“…Although gentamicin is mainly toxic to the vestibule, ototoxicity is an important concern and can be encountered in up to 34% of the treated patients depending on the dose regimen and number of injections [1] . Different ITG application protocols have been described recently in order to achieve complete or substantial vertigo control with minimal risk of ototoxicity [2][3][4][5][6] .…”

Section: Introductionmentioning

confidence: 99%

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Cochlear and Vestibular Effects of Combined Intratympanic Gentamicin and Dexamethasone

Günerı

Olgun²,

Aslıer³

et al. 2017

Int Adv Otol

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OBJECTIVE:The aim of this study is to evaluate the effects of an intratympanic gentamicin-dexamethasone combination on the inner ear. MATERIALS and METHODS:Twenty-six Wistar albino rats were divided into four groups: Group I (Control), group II (Intratympanic dexamethasone; ITD), group III (Intratympanic gentamicin; ITG), and group IV (Intratympanic gentamicin and dexamethasone; ITGD). On the first day after basal auditory brainstem response (ABR) measurements, the ITG group received 0.03 mL of intratympanic gentamicin (26.7 mg/mL). Intratympanic injection of 0.06 mL of a solution containing 13.35 mg/mL gentamicin and 2 mg/mL dexamethasone was performed in the ITGD group. 0.03 mL of physiological intratympanic serum and dexamethasone (4 mg/mL) was applied in control and ITD groups, respectively. On the 7 th day, ABR measurements were repeated and vestibular functions were evaluated. On the 21 th day, ABR and vestibular tests were repeated, and the animals were sacrificed for histopathological investigation. RESULTS:The ITG group's hearing thresholds deteriorated in all frequencies. The ITGD group's hearing thresholds were significantly better than the ITG group, except at 8 kHz on the 7 th day and in all frequencies at the 21 th day measurements. The vestibular function scores of the ITG and ITGD groups were higher than the controls. Apoptotic changes were seen in cochlea, spiral ganglion, and vestibule of the ITG group. Cochlear and vestibular structures were well preserved in the ITGD group, similar to the controls. CONCLUSION:The ITGD combination led to a significant hearing preservation. Although in subjective vestibular tests, it seemed that vestibulotoxicity was present in both ITG and ITGD groups the histopathological investigations revealed no signs of vestibulotoxicity in the ITGD group in contrast to the ITG group. Further studies using a combination of different concentrations of gentamicin and dexamethasone are needed.

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Endolymphatic Sac Surgery for Ménière's Disease

Wetmore¹

2008

Arch Otolaryngol Head Neck Surg

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Objective: To analyze the results of primary and revision endolymphatic sac surgery for the treatment of Ménière's disease in patients who failed medical therapy.Design: Retrospective medical chart review.Setting: Tertiary referral center.Patients: Fifty-one adult patients with Ménière's disease who failed medical therapy.Interventions: Endolymphatic sac to mastoid shunts were performed. Revision sac procedures were performed in patients who developed clinically significant recurrent vertiginous spells 5 months or longer after their original procedure.Main Outcome Measures: Frequency of major vertiginous episodes measured by the standards listed in the 1995 American Academy of Otolaryngology guidelines for evaluation of therapy in Ménière's disease.Results: Twenty-four months after primary sac surgery, 27 patients (53%) exhibited class A results (no vertigo), and 12 (24%) exhibited class B results (1%-40% of baseline). In 14 patients undergoing revision sac surgery, 5 (36%) showed class A results and 4 (29%) showed class B results. Patients who failed treatment with sac surgery more than 24 months after their primary procedure obtained better results than those who failed treatment less than 24 months after their initial sac procedure. In the 37 patients who had long-term follow-up (mean duration of follow-up, 88 months) after their last sac procedure, 57% exhibited class A results (21 cases) and 35% exhibited class B results (13 cases).Conclusions: Endolymphaticsacsurgeryprovidedimprove-mentinmajorspellsofvertigoin77%ofpatientsat24months aftersurgery.Revisionsurgeryprovidedimprovementin65% of cases. Results of revision surgery were better in those patients who developed recurrent symptoms more than 24 months after their original procedure compared with those of patients who failed treatment earlier.

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Intratympanic Gentamicin Therapy for Ménière’s Disease: A Meta-analysis

Cited by 171 publications

References 21 publications

Longitudinal Results With Intratympanic Dexamethasone in the Treatment of Ménière's Disease

Longitudinal Results With Intratympanic Dexamethasone in the Treatment of Ménière's Disease

Cochlear and Vestibular Effects of Combined Intratympanic Gentamicin and Dexamethasone

Endolymphatic Sac Surgery for Ménière's Disease

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