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Otolaryngol Head Neck Surg. 2014 May;150(5):847-52. doi: 10.1177/0194599813520398. Epub 2014 Jan 29.

Intratympanic gentamicin for Meniere's disease: short- and long-term follow-up of two regimens of treatment.

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  • 1Department of Surgery and Medicine, Otorhinolaryngology Unit, Pisa University Hospital, Pisa, Italy.

Abstract

OBJECTIVES:

(1) To compare the results of the 2 regimens of treatment at 2-year follow-up and (2) to evaluate the need and the efficacy of retreatment after the recurrence of vertigo attacks in a longer period of follow-up (using the Kaplan-Meier method of analysis).

STUDY DESIGN:

Retrospective chart review.

SETTING:

Tertiary referral center.

SUBJECTS AND METHODS:

We analyzed 77 patients treated with intratympanic gentamicin (ITG). Thirty-five patients were treated with high-dose (HD) ITG (in total 6 injections, twice a day, repeated every 3 days) and 42 with low-dose (LD) ITG (1-2 injections). The results of treatment were evaluated in terms of functional level scale, control of vertigo, and hearing impairment.

RESULTS:

At 2-year follow-up, a similar percentage of vertigo control was obtained in the 2 groups; the incidence of hearing loss and posttreatment disequilibrium was significantly higher in patients treated with HD-ITG. The long-term follow-up showed a control of vertigo attacks with a single round of treatment in 71.4% of patients treated with HD-ITG and in 55% of those treated with LD-ITG. With repeated rounds, an effective control of vertigo could be achieved in 88.5% using a HD-ITG protocol and 97.7% using a LD-ITG protocol.

CONCLUSIONS:

LD-ITG allows obtaining good results in term of vertigo attacks associated with a limited occurrence of side effects. The long-term follow-up showed that LD-ITG needed repeated rounds more frequently than the HD-protocol. HD-ITG ran less risk of needing repeated rounds, but retreatment was ineffective in 40% of the cases requiring surgical therapy.

KEYWORDS:

Ménière’s disease; dizziness; gentamicin; intratympanic; vertigo

PMID:
24477826
[PubMed - indexed for MEDLINE]
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