Long-term follow-up of transtympanic gentamicin for Ménière's syndrome.
OBJECTIVE
Recent studies have shown that transtympanic gentamicin for Ménière's syndrome is effective. Current treatment protocols vary. One concept has been to perform a chemical ablation; the other has been to perform a chemical alteration. Ablation requires multiple injections and is effective in controlling the vertigo, but it is associated with a significant incidence of hearing loss. Chemical alteration uses a minimal dose to reduce vestibular function without affecting cochlear function.


METHODS
Prospective.


METHODS
Tertiary medical center.


METHODS
Patients had classic unilateral Ménière's syndrome that was unresponsive to medical therapy.


METHODS
A single injection of gentamicin is given, and the patient is seen 1 month after injection. If indicated, the patient receives another injection and is reevaluated 1 month later.


METHODS
Control of vertigo and maintenance of hearing using the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) guidelines (1995).


RESULTS
Fifty-six patients have documented follow-up for 2 years or more, and 21 have 4 years or more of follow-up. This article presents the 4-year results as outlined by the AAO-HNS guidelines. Vertigo classes A and B were seen in 82% of patients. The patients followed 2 to 4 years had 86% vertigo class A and B results. Those followed 4 years or more show 76% with a vertigo class A or B result. In this study there has been minimal cochlear loss. There was vestibular change clinically, which was documented by electronystagmography.


CONCLUSIONS
It appears that a single transtympanic gentamicin injection is effective in controlling the vertigo of Ménière's syndrome. Cochlear impact has been minimal. It is most useful for those patients who have failed medical management and are severely affected but not totally incapacitated by the disease.
Harner
S G
SG
Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota 55905, USA.
Driscoll
C L
CL
Facer
G W
GW
Beatty
C W
CW
McDonald
T J
TJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001301:Audiometry, Pure-Tone / Q000379:methods; D004333:Drug Administration Routes; D004584:Electronystagmography; D005500:Follow-Up Studies; D005839:Gentamicins / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007267:Injections; D008575:Meniere Disease / Q000175:diagnosis / Q000188:drug therapy*; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index; D014717:Vertigo / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D014724:Vestibular Function Tests; D014722:Vestibule, Labyrinth / Q000503:physiopathology
D000900:Anti-Bacterial Agents; D005839:Gentamicins