Factors Relating to the Vertigo Control and Hearing Changes Following Intratympanic Gentamicin for Intractable Ménière's Disease

Horii, Arata; Saika, Takanori; Uno, Atsuhiko; Nishiike, Suetaka; Mitani, Kenji; Nishimura, Masato; Kitahara, Tadashi; Fukushima, Munehisa; Nakagawa, Aya; Masumura, Chisako; Sasaki, Tomo; Kizawa, Kaoru; Kubo, Takeshi

doi:10.1097/01.mao.0000227663.79210.c1

Cited by 14 publications

(3 citation statements)

References 16 publications

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“…Among other physiological or imaging tests, electrocochleography was included in 1 study (14), rotating chair in 2 studies (8,9), auditory brainstemevoked potentials in no study, vestibular evoked myogenic potentials in 1 study (15), computed tomography in 2 studies (6,16), and magnetic resonance imaging in 3 studies (6,13,16). All studies used outcomes measures consistent with AAO-HNS guidelines (12).…”

Section: Patient Assessments and Outcomes Measuresmentioning

confidence: 99%

Outcome of Intratympanic Gentamicin Injection for Ménière Disease

Huon¹,

Fang²,

Wang³

2011

Otolaryngol.--head neck surg.

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window can be used to control symptoms. It provides an alternative to the plugging and resurfacing techniques. This procedure is simple to perform, is reversible, and can be undertaken as a day case. Otology/NeurotologyOutcome of intratympanic Gentamicin injection for Ménière Disease Leh-Kiong Huon (presenter); Te-Yung Fang; Pa-Chun Wang, MD, MScObjective: Intratympanic genemicin (ITG) is an option for the treatment of intractable Ménière disease (MD). The aim of this study is to investigate the outcomes of ITG for MD using evidence-based methodology. Method:The MedLine database (1985~2010) was searched for original articles (level I or II in evidence strength) published in peer-reviewed journals concerning ITG for MD. Data extracted from these articles were reviewed and analyzed using meta-analysis technology.Results: A total of 15 articles were clitically appraised; 2 prospective, double-blinded randomized control trials (level I) and 13 prospective noncontrolled clinical trials (level II) were indentified. The pooled vertigo control rates (American Academy of Otolaryngology Head and Neck Surgery guidelines for Ménière disease) from 15 studies are: overall control rate 78% (class A, 95% CI 0.67-0.85), substantial control rate 56 % to 98% (class A and B, 95% CI 0.25-1.0) following ITG treatment (P = .0001). Hearing is worse in 0% to 61% (95% CI 0.02-0.83) after gentamicin treatment, which was neither clinically nor statistically significant (P = 1.000). Conclusion:The critical literature and meta-analyses show that ITG can control vertigo for MD patients with limited injury to hearing. Quality of research has improved remarkably over the years. However, a large scale, randomized controlled trial is warranted to confirm the predicting factors for the true effectiveness of ITG in treating MD. Otology/NeurotologyOutpatient labyrinthectomy Kevin X. McKennan, MD (presenter) Objective: With newly available anti-nausea/vertigo medications, selected patients can undergo transmastoid labyrinthectomy as an outpatient procedure.Method: Ten patients pretreated with a cocktail of Emend/ Transderm Scop Patch/Decadron underwent a transmastoid labyrinthectomy. These patients were all treated as outpatients. These 10 patients will be compared with 10 similar patients hospitalized after surgery. Method: A retrospective chart review was performed from January 1, 1999 until January 1, 2011, to identify patients under 17 years old who underwent a stapedectomy. Age, gender, pre-and postoperative audiograms, intraoperative findings including cause of stapes fixation, type of prosthesis used, and complications were recorded.Results: Eighteen children were identified who had undergone a stapedectomy. The cause of fixation included otosclerosis (n = 7), congenital footplate fixation (n = 9), and unknown cause (n = 2). The overall mean preoperative air-bone gap (ABG) was 35.7 dB (±10.4), compared with a postoperative mean ABG of 15.1 (±15.6) (P < 000.1). The mean postoperative ABG of 14.5 (±5.3) in the congenital footplate fixation gr...

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Section: Patient Assessments and Outcomes Measuresmentioning

confidence: 99%

Outcome of Intratympanic Gentamicin Injection for Ménière Disease

Huon¹,

Fang²,

Wang³

2011

Otolaryngol.--head neck surg.

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“…Encontramos 13 revisiones sistemáticas [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], que incluyeron 80 estudios primarios [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39], [40], [41], [42], [43], [44], [45], [46], [47], [48], [49], [50], [51], [52], [53],…”

Section: Acerca Del Conjunto De La Evidencia Para Este Problemamentioning

confidence: 99%

Intratympanic gentamicin compared with placebo for Ménière's disease

Amesti¹,

Santander²,

Winter³

2022

Medwave

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INTRODUCTION Ménière's disease is a multifactorial disorder affecting the inner ear, characterized by episodes of spontaneous and recurrent vertigo, fluctuating hearing loss and tinnitus. Intratympanic gentamicin therapy has been used to reduce the intensity and frequency of attacks in intractable Ménière's disease, but it is associated with hearing loss. There is controversy regarding its efficacy and safety. METHODS We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS We identified 13 systematic reviews that included 80 primary studies overall, of which three correspond to randomized trials. We concluded that intratympanic gentamicin may improve the control of vertigo, and result in little or no difference to tinnitus, but the certainty of the evidence is low. Furthermore, we are uncertain whether intratympanic gentamicin reduces hearing or the frequency of vertigo attacks as the certainty of the evidence has been assessed as very low.

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“…Moreover, it has been hypothesized that intratympanic gentamicin may even induce the recovery of the vestibular function by damaging the secretory functions of the vestibular dark cells, thus inhibiting or reducing endolymphatic hydrops. Horii et al 17 and thereby block the neurotransmission between hair cells and the vestibular nerve, resulting in a decrease in vertigo spells. Damage to the cochlear function is the major concern of intratympanic gentamicin perfusion.…”

Section: Labyrinthectomy Versus Intratympanic Aminoglycosidesmentioning

confidence: 99%

Labyrinthectomy and Vestibular Neurectomy for Intractable Vertiginous Symptoms

Alarcón

Hidalgo

Arévalo

et al. 2017

Int Arch Otorhinolaryngol

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Introduction Labyrinthectomy and vestibular neurectomy are considered the surgical procedures with the highest possibility of controlling medically untreatable incapacitating vertigo. Ironically, after 100 years of the introduction of both transmastoid labyrinthectomy and vestibular neurectomy, the choice of which procedure to use rests primarily on the evaluation of the hearing and of the surgical morbidity. Objective To review surgical labyrinthectomy and vestibular neurectomy for the treatment of incapacitating vestibular disorders. Data Sources PubMed, MD consult and Ovid-SP databases. Data Synthesis In this review we describe and compare surgical labyrinthectomy and vestibular neurectomy. A contrast between surgical and chemical labyrinthectomy is also examined. Proper candidate selection, success in vertigo control and complication rates are discussed on the basis of a literature review. Conclusions Vestibular nerve section and labyrinthectomy achieve high and comparable rates of vertigo control. Even though vestibular neurectomy is considered a hearing sparing surgery, since it is an intradural procedure, it carries a greater risk of complications than transmastoid labyrinthectomy. Furthermore, since many patients whose hearing is preserved with vestibular nerve section may ultimately lose that hearing, the long-term value of hearing preservation is not well established. Although the combination of both procedures, in the form of a translabyrinthine vestibular nerve section, is the most certain way to ablate vestibular function for patients with no useful hearing and disabling vertigo, some advocate for transmastoid labyrinthectomy alone, considering that avoiding opening the subarachnoid space minimizes the possible intracranial complications. Chemical labyrinthectomy may be considered a safer alternative, but the risks of hearing loss when hearing preservation is desired are also high.

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Factors Relating to the Vertigo Control and Hearing Changes Following Intratympanic Gentamicin for Intractable Ménière's Disease

Cited by 14 publications

References 16 publications

Outcome of Intratympanic Gentamicin Injection for Ménière Disease

Outcome of Intratympanic Gentamicin Injection for Ménière Disease

Intratympanic gentamicin compared with placebo for Ménière's disease

Labyrinthectomy and Vestibular Neurectomy for Intractable Vertiginous Symptoms

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