Treatment of Ménière's Disease With "On-Demand" Intratympanic Gentamicin Injections

Abstract

On-demand administration of intratympanic gentamicin provides an alternative treatment for medically refractory Ménière's disease. Moreover, the Kaplan-Meier analysis was useful to analyze recurrent manifestations, such as vertigo attacks in Ménière's disease.

Single intratympanic gentamicin injection in Ménière's disease: VOR change and prognostic usefulness

“…Over the years, there has been a trend toward the use of smaller doses of gentamicin and/or longer intervals between injections. As a consequence, there has been a reduction of side effects such as hearing loss and posttreatment disability . In a 2‐year follow‐up study, we have already shown that there is a 50% chance of complete resolution of vertigo spells after one instillation of gentamicin, which is in accordance with other researchers …”

“…A 24‐month period of time has been recommended by the American Academy of Otolaryngology Head‐and‐Neck Surgery guidelines for reporting results in MD. No recurrences were previously seen in the one that we are reporting …”

“…The medication used was gentamicin sulfate (40 mg/ml) buffered with sodium bicarbonate to pH 6.4 and a final concentration of 26.7 mg/ml, which was intratympanically injected. The methods have been previously detailed elsewhere . The study was performed according to the following protocol, as previously approved by the ethics and medical deontology commission at our hospital.…”

Magnetic Resonance Imaging Fails to Show Evidence of Reduced Endolymphatic Hydrops in Gentamicin Treatment of Ménière’s Disease

“…Improved experience on this treatment modality has made evident that ITGent works even in the absence of a complete vestibular deafferentation (2Y4, 8,9,15). As a result, ITGent dosage has progressively been reduced, and some authors remark that a therapeutic effect is produced after 1 or 2 single-shot applications, with the appreciable advantage of minimizing risk of hearing deterioration (2,3,8Y10,14,16).…”

Variability in the perilymphatic diffusion of gadolinium does not predict the outcome of intratympanic gentamicin in patients with ménière's disease

“…ITGent injection was administered within a variable period of time from 1 week to 3 weeks after 3D‐FLAIR MRI. A single‐shot administration protocol was attempted with additional injections administered on demand in the case of relapsing vertigo spells 9, 10. At least a 1‐month interval between the administrations was observed.…”