Low-dose intratympanic gentamicin administration for unilateral Meniere's disease using a method based on clinical symptomatology: Preliminary results

Scarpa, Aldo; Ralli, Massimo; Cassandro, Claudia; Gioacchini, Federico Maria; Alicandri‐Ciufelli, Matteo; Viola, Pasquale; Chiarella, Giuseppe; Vincentiis, Marco de; Cassandro, Ettore

doi:10.1016/j.amjoto.2019.102289

Cited by 23 publications

(9 citation statements)

References 40 publications

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“…Gentamicin, administered at different doses and timing 25 , has been proven as an effective treatment for vertigo control in MD with a potential risk of herring loss; however, discussion about the dosage and the method used is open 26 . Scarpa et al 27 proposed a low-dose IT gentamicin protocol; they treated 48 patients with 0.5 ml of 10 mg of gentamicin with an interval of 2 weeks between injections. They reported a satisfactory control of vertigo attacks after IT gentamicin, and the effect of this protocol on vestibular system was proved by the reduction in vestibulo-ocular reflex (VOR) gain in the affected side.…”

Section: Discussionmentioning

confidence: 99%

Pharmacological, surgical and diagnostic innovations in Meniere’s disease: a review

Scarpa

Ralli²,

Bonis

et al. 2020

Translational Medicine @ UniSa

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Meniere's disease is an inner ear disorder characterized by the presence of endolymphatic hydrops in the inner ear and symptomatology of recurrent and debilitating vertigo attacks, tinnitus, aural fullness, and fluctuating sensorineural hearing loss. Although many therapeutic options for MD have been proposed during years, no consensus has been reached by the scientific community. In the last decade, many therapeutic options have been proposed, as intratympanic steroid, intratympanic gentamicin, and intravenous glycerol. Recently, the role of the antisecretory factor in the diet of MD patients have been investigated. Surgery is recommended for intractable MD; some authors proposed new approaches including transcanal endoscopic infracochlear vestibular neurectomy, new marsupiliazation technique in sac surgery, and tenotomy of the stapedius and tensor tympani muscles.

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Section: Discussionmentioning

confidence: 99%

Pharmacological, surgical and diagnostic innovations in Meniere’s disease: a review

Scarpa

Ralli²,

Bonis

et al. 2020

Translational Medicine @ UniSa

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“…In the common view, a maximum of 3–5 ITG injections could be performed in each patient. Treatment was stopped when the patient had no episodes of vertigo in a 3 month period [ 31 ] or objective testing (videonystagmography, rotatory chair) revealed a vestibular loss in the affected ear [ 12 ].Vestibular ocular reflex (VOR) changes after ITG in video-head impulse test (vHIT) could foresee short-term control of vertigo attacks. If the difference value of gain asymmetry between the symptomatic and asymptomatic ear in the horizontal semicircular canal was greater than 7% and the amount of vestibular function reduction in the symptomatic ear, evaluated with the VOR gain, was greater than 17.8%, the second ITG injection could be avoided [ 32 ].…”

Section: Intratympanic Corticosteroidsmentioning

confidence: 99%

Consensus on intratympanic drug delivery for Menière’s disease

Pyykkö

Zhang

et al. 2022

Eur Arch Otorhinolaryngol

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Purpose Intratympanic (IT) drug delivery receives attention due to its effectivity in treatment for Menière’s disease (MD). Due to the release of the consensuses and new evidence on IT drug delivery for MD have been published, the review with a view to supplementing the details of IT treatment of MD is indispensable. Methods The literatures on IT injection for MD treatment over the last two decades are retrieved, International consensus (ICON) on treatment of Menière’s disease (2018), Clinical Practice Guideline (2020) and European Position statement on Diagnosis and Treatment of Meniere’s Disease (2018) are taken into account for reference, and follow advice from experts from Europe, USA and China. Results Experts agree on the following: (1) The effectiveness of IT methylprednisolone (ITM) on vertigo control seems to be somewhat better than that of IT dexamethasone (ITD), and ITM can restore hearing in some cases. (2) Due to the ototoxicity of aminoglycosides, the application of intratympanic gentamicin (ITG) in MD patients with good hearing is conservative. However, some studies suggest that ITG with low doses has no significant effect on hearing, which needs to be further proved by clinical studies with high levels of evidence. (3) Currently, generally accepted treatment endpoint of ITG is no vertigo attack in a 12-month period or a vestibular loss in objective tests in the affected ear. Conclusion More studies with high level of evidence are needed to evaluate the drug type, efficacy, and therapeutic endpoint of IT therapy for MD.

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“…It can be accompanied by a feeling of fullness in the affected ear, while the acute episode of nausea and vomiting. 1,3,4,[8][9][10] Persistent vertigo, underlying hearing loss, and tinnitus can cause anxiety and other psychological disorders such as neurosis and / or depression. 9…”

Section: Clinical Picturementioning

confidence: 99%

“…Corticosteroids have a lower risk of hearing damage, but less effective in controlling attacks of vertigo compared to gentamicin, which has a potential risk of hearing loss. 1,9 In a study of 69 patients, 36 were treated with IT dexamethasone (4 mg/dl) and 33 with IT methylprednisolone (40 mg/dl). Initially, vertigo control was 75% and 66% for dexamethasone and methylprednisolone, respectively.…”

Section: Medical Treatmentmentioning

confidence: 99%

Comparative analysis of the effectiveness of the alternatives current treatments in Meniere’s disease

Pérez

Torres

Zarate

et al. 2022

Int J Otorhinolaryngol Head Neck Surg

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<p class="abstract">The objective is to compare the efficacy of the treatments currently used in Ménière's disease, assessing their advantages and disadvantages. A bibliographic review was carried out with 11 original articles, of which 10 are in English and 1 in Spanish, from 3 years to date in Journal of Vestibular Research, Otology & Neurotology, European Archives Oto-Rhino-Laryngology, American Journal of Otolaryngology, Laryngoscope Investigative Otolaryngology, Journal of Neurology, Iranian Journal of Otorhinolaryngology, Revista Ciencia y Salud, respectively. The following books were consulted Harrison's Principles of Internal Medicine; Oído, nariz, garganta y cirugía de cabeza y cuello; Diagnóstico y tratamiento en otorrinolaringología. Cirugía de cabeza y cuello; and, Tratado de otorrinolaringología y patología cervicofacial. Medical treatment with dexamethasone, gentamicin, betahistine and diuretics was evaluated, as well as surgical treatment with endolymphatic sac surgery, vestibular neurectomy and labyrinthectomy. Treatment is individualized, however, betahistine is recommended as the first option, followed by IT gentamicin for the control of vertigo.</p>

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Low-dose intratympanic gentamicin administration for unilateral Meniere's disease using a method based on clinical symptomatology: Preliminary results

Cited by 23 publications

References 40 publications

Pharmacological, surgical and diagnostic innovations in Meniere’s disease: a review

Pharmacological, surgical and diagnostic innovations in Meniere’s disease: a review

Consensus on intratympanic drug delivery for Menière’s disease

Comparative analysis of the effectiveness of the alternatives current treatments in Meniere’s disease

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