Update on Intratympanic Gentamicin for Meniere's Disease

Blakley, Brian W.

doi:10.1097/00005537-200002010-00009

Cited by 143 publications

(109 citation statements)

References 15 publications

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“…Following endolymphatic duct obstruction, guinea pigs are more susceptible to aminoglycoside toxicity (Kimura et al 1991), a finding which suggests that hair cell vulnerability is influenced by the state of cells within the spiral ligament. Another indication that the state of nonsensory cells can affect susceptibility to aminoglycoside toxicity is the well-known synergistic toxic interaction of aminoglycosides and loop diuretics first described by Brummett et al (1975). Synergistic toxic interactions of aminoglycosides and loop diuretics have been studied repeatedly, and a similar toxic synergistic action also occurs with combined kanamycin and aminooxyacetic acid (AOAA), a drug that, like loop diuretics, reduces the endolymphatic potential (Bryant et al 1984).…”

Section: Introductionmentioning

confidence: 99%

Distribution of Gentamicin in the Guinea Pig Inner Ear after Local or Systemic Application

Imamura

Adams

2003

JARO - Journal of the Association for Research in Otolaryngolog

110

112

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Uptake and retention of gentamicin by cells in the guinea pig inner ear after a single peritoneal injection or local application on the round window were investigated using immunocytochemistry to localize the drug. The cells that accumulated the drug under the two conditions were the same, but staining for the drug was more intense and was often accompanied by widespread cochlear degeneration following local application. Soon after drug administration by either route, there was diffuse staining for the drug throughout all tissue within the labyrinth, including bone. At later times when distinct cell staining became evident, virtually all cell types were found to be positive, with several cell types staining more darkly for the drug than hair cells, indicating that hair cells were not the most avid in accumulating gentamicin. The infracuticular portion of auditory and vestibular hair cells as well as type III fibrocytes of the spiral ligament were positively stained in almost all cases and these sites were found to be positive for as long as six months post administration. In animals with loss of the organ of Corti, there was unusually intense staining for gentamicin in root cells of the spiral ligament, in marginal cells of the stria vascularis, and in cells of the spiral limbus. Dark staining of surviving cells in cases with overt tissue destruction suggests that variability in the extent of damage caused by the drug was determined more by the degree of its local uptake than by differences in animals' capacities to metabolize the drug systemically. The present results show that gentamicin may damage or destroy all cochlear cells following a single round window application. The findings broaden the scope of our knowledge of cochlear gentamicin uptake and damage and have implications for treatment of patients with vestibular disorders by infusion of aminoglycosides into the middle ear, as well as implications for prospects of rehabilitating patients that have been deafened by aminoglycosides.

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Section: Introductionmentioning

confidence: 99%

Distribution of Gentamicin in the Guinea Pig Inner Ear after Local or Systemic Application

Imamura

Adams

2003

JARO - Journal of the Association for Research in Otolaryngolog

110

112

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“…In previous studies utilizing both fi xed dosing regimens and titration protocols, vertigo control rates were similar, but a signifi cantly higher level of hearing loss was noted in patients receiving fi xed-dose perfusions [15,19]. Though a review of recent literature by Blackley [18] found no signifi cant difference in two regimens, we prefer chemical altering titration schedule compared to chemical ablating fi xed dose schedule. The recurrence rates are slightly higher in titration schedule [19,20], but this recurrent vertigo responded well to additional intratympanic gentamicin injections without changes in hearing.…”

Section: Discussionmentioning

confidence: 77%

“…No systematic effects are found for different concentrations of gentamicin (from 10 to 40 mg/mL). Different techniques of delivery (by direct needle injection, tympanostomy tube, microwick or catheter) do not appear to affect the fi nal outcome [18] and therefore direct needle injection, which is easiest, is preferred. Neither the concentration nor the amount delivered affects the effi cacy [18] and therapy is terminated based on the effects observed.…”

Section: Discussionmentioning

confidence: 99%

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Is surgical vestibular ablation necessary in disabling peripheral vertigo?

Mahadevaiah¹,

Parikh²

2008

Indian J Otolaryngol Head Neck S

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The use of intratympanic gentamicin is an easily performed offi ce procedure for the conservative treatment of the Meniere's disease patient who has failed medical therapy. The procedure provides excellent control for the symptom of vertigo and is one of the most successful methods in the treatment of vertigo due to inner ear disorders. Surgical ablation is no longer necessary for adequate control of vestibular symptoms and that chemical ablation/ alteration may replace the need for surgical vestibular ablation in cases of disabling Meniere's disease and other inner ear causes for peripheral vertigo.

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“…Hearing aids are often ineffective because patients suffer from poor speech discrimination, as well as diminished tolerance to amplified sound. Chemical labyrinthectomy with gentamicin is now a common nonsurgical option for control of vertigo if medical management fails (6). Full complement of symptoms of MD does not develop simultaneously in some cases.…”

Section: Journalmentioning

confidence: 99%

Atypical Meniere Disease: Case Report of a Patient Treated as Sudden Hearing Loss

Bayındır¹,

Karataş²,

Çetinkaya³

2012

J Turgut Ozal Med Cent

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Meniere's disease is an idiopathic disease involving the inner ear, which is characterized by fluctuating low frequency sensorineural hearing loss, tinnitus, aural fullness, and recurrent vertigo. We could see the Meniere's disease without vestibular symptom in some cases. These cases have been reported as atypical (Cochlear) Meniere's disease. We have evaluated a patient of atypical Meniere's disease followed as sudden hearing loss with fluctuating low tone type sensorineural hearing loss without vertigo. Sudden deafness, cochlear sensorineural hearing loss, chronic progressive sensorineural hearing loss, presenile presbycusis, noise induced and autoimmune sensorineural hearing loss may be confused in diagnosis of Meniere disease.

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Update on Intratympanic Gentamicin for Meniere's Disease

Cited by 143 publications

References 15 publications

Distribution of Gentamicin in the Guinea Pig Inner Ear after Local or Systemic Application

Distribution of Gentamicin in the Guinea Pig Inner Ear after Local or Systemic Application

Is surgical vestibular ablation necessary in disabling peripheral vertigo?

Atypical Meniere Disease: Case Report of a Patient Treated as Sudden Hearing Loss

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