Benign paroxysmal positional vertigo in patients with Ménière's disease treated with intratympanic gentamycin.
OBJECTIVE
To analyze the incidence and characteristics of benign paroxysmal positional vertigo (BPPV) in patients with Ménière's disease who did not respond to medical treatment and to whom intratympanic gentamycin treatment was proposed.


METHODS
This is a retrospective analysis of the patients in our database. A complete otoneurologic bedside examination of each patient, including assessment of positional nystagmus, was performed at the time of diagnosis and during the follow-up.


RESULTS
Nine of 90 patients with Ménière's disease also had BPPV, which manifested in different ways. In 3 patients, BPPV preceded the onset of Ménière's symptomatology in the same ear; in 1, BPPV manifested after treatment for Meniere's disease had ended and the patient was in complete control of the spontaneous spells of vertigo; in 5 cases, recurrences of both Meniere's disease and the positioning symptomatology coincided. Treatment for each condition was conducted independently and favorable results were obtained after long-term follow-up when Meniere's disease and BPPV did not coincide simultaneously. In the group manifesting symptoms of both disorders at the same time, gentamycin treatment with the Canalith Repositioning Procedure and/or Semont maneuver partially resolved the symptoms.


CONCLUSIONS
In the context of Ménière's disease, the sequence of appearance of BPPV relative to the spontaneous episodes must be taken into account when planning the treatment for each of the disorders, which should be considered independently. This pattern could also influence the prognosis for each disorder.
Perez
Nicolas
N
Department of Otolaryngology, University Hospital and Medical School, University of Navarra, Spain. nperezfer@unav.es
Martin
Eduardo
E
Zubieta
Jose Luis
JL
Romero
Maria Dolores
MD
Garcia-Tapia
Rafael
R
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D005839:Gentamicins / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008575:Meniere Disease / Q000150:complications* / Q000188:drug therapy*; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D014432:Tympanic Membrane; D014717:Vertigo / Q000209:etiology*
D000900:Anti-Bacterial Agents; D005839:Gentamicins