To print: Select File and then Print from your browser's menu --------------------------------------------------------------------------------------- Title: DG Dispatch - Meniere's Disease: Intratympanic Gentamicin Offers Conservative Treatment For Vertigo URL: http://www.pslgroup.com/dg/F4836.htm Doctor's Guide April 14, 1999
By Tuy Nga Brignol Special to DG News PARIS, FRANCE -- April 14, 1999 -- Intratympanic gentamicin therapy (IGT) is a particularly conservative regimen when trying to minimise the risk of further hearing loss, according to H. Alexander Arts, MD, from the University of Michigan Medical Center. IGT is a chemical labyrinthectomy for treatment of unilateral Meniere's disease. One of the significant risks of IGT is exacerbation of hearing loss. Patients selected for the study were those for whom routine medical treatment had failed. The follow-up period ranged from five to 40 months. A total of 22 patients ranging in age from 26 to 82 years (median 72 years) received an injection of gentamicin 40 mg/ml, undiluted and unbuffered, into the middle ear. A further injection is performed only if further spontaneous attacks of vertigo persist after a two-week waiting period. According to Dr. Arts, the vertigo control achieved in this study was similar to that in other studies. In addition, about 25 percent of patients showed further hearing loss which appears to be injection-related. These patients also showed further hearing loss with each injection. Conversely, a distinct subgroup did not develop hearing loss in spite of repeated injections. Vestibular Neurotomy By Retrosigmoid Approach According to the results of a study presented by S. Dejardin of Cliniques Universitaires Saint-Luc, UCL, Brussels, Belgium, vestibular neurotomy by retrosigmoid approach is the treatment of choice in Meniere's disease with refractory, incapacitating vertigo after the failure of medical therapies. A total of 34 patients who underwent vestibular neurotomy from 1992 to 1998 were reviewed retrospectively. A questionnaire was sent to evaluate the patients level of satisfaction with surgery. Since 1996, results on equilibrium were assessed by means of dynamic posturography (Equitest). According to Dr. Dejardin, the results of this study demonstrate that vestibular neurotomy provides excellent control of vertigo and unsteadiness (normal equitest at two months) with good preservation of hearing. In addition, none of the patients reported any damage to facial nerves as a result of the surgical procedure. Retrosigmoid Vestibular Neurotomy Performed Early Avoids Hearing Loss According to the results of a study presented by Jacques Magnan of CHU Nord, Marseille, France, retrosigmoid vestibular neurotomy should be performed at an early stage of Meniere's disease to preserve hearing. The retrosigmoid approach provides direct access to the whole cerebellopontive angle and allows easy isolation of each component of the acousticofacial nerve bundle, Dr. Magnan explained. In this study, 93 cases of 283 patients with Meniere's disease who had undergone vestibular neurotomy were followed over five years. The average threshold of preoperative hearing level was 49 dB. The average threshold hearing level one year after surgery was 46 dB and five years after surgery was 53 dB. After five-year follow-up period, eight cases (8.6 percent) improved by more than 20 dB, 14 cases (15.05 percent) worsened, 71 cases (76.34 percent) remained unchanged. Hearing was unchanged in 12 cases (12.90 percent) in the subgroup of 15 cases who had a preoperative threshold between 10 dB to 20 dB. Four cases developed controlateral symptoms (three cases of fluctuating hearing, one case of vertigo). Onset Of Second Ear Troubles In Bilateral Meniere's Disease According to the results of the study presented by R. Naito of University of Tokyo, Japan, there should be a five-year waiting period before undertaking destructive therapy. This retrospective study involved 23 patients (nine men, 14 women) with bilateral Meniere's disease, ranging in age from 23 to 74 years (mean 54.7), whose duration of illness ranged from less than one year to 14 years (mean 6.3 years). All cases were diagnosed as having definite Meniere's disease -- repeated attacks of vertigo, fluctuant cochlear symptoms in both ears without central nervous system involvement. According to Dr. Naito, three patients (12.5 percent) had appearance of symptoms nearly simultaneously in both ears and 20 patients (87.5 percent) had delayed onset of symptoms in the first and the second ear. In most patients, symptoms in the second ear occurred within five years after the onset of the first ear. --------------------------------------------------------------------------------------------- Copyright © 1999 P\S\L Consulting Group Inc. All rights reserved. Republication or redistribution of P\S\L content is expressly prohibited without the prior written consent of P\S\L. 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