Selective Window Application of Gentamicin Dexamethasone in Meniere's Disease

Abstract

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.

Effects of an Intratympanic Injection of Dexamethasone Combined with Gentamicin on the Expression Level of Serum P0 Protein Antibodies in Patients with Meniere's Disease

“…Ardıç and colleagues compared the efficacy for 25 patients with MD between dexamethasone combined with gentamicin and gentamicin alone. Their results showed that patients treated with gentamicin alone had severe high-frequency hearing loss, while patients treated with dexamethasone and gentamicin had protected auditory and vestibular cells ( 22 ), further confirming our conclusions.…”

CT imaging of the Eustachian tube using focal contrast medium administration: a feasibility study in humans

“…Nevertheless, we considered the risk of ototoxicity to be extremely low. Substances such as CM and antibiotics can pass through the round window membrane (19)(20)(21) and the oval window membrane (20,22,23), but also diffuse into the labyrinth from the blood stream (20,22). We chose iodixanol (Visipaue TM ) as the CM, both in our animal study (13) and in this human study, due to its properties.…”