[Intratympanic gentamycin in association with human fibrin glue in the treatment of Meniere's disease: preliminary results].
The treatment of Menierè's disease (Md) with intratympanic gentamicin has rapidly become one of the most widespread alternatives to surgery in this disorder. Numerous studies, employing different protocols, have reported the use of this antibiotic in the treatment of disabling forms of Md, with success rates in the control of vestibular symptoms varying from 73 to 100%, associated with a rate of hearing complications varying from 0 to 75%. We have reported the results of a preliminary experience carried out in 10 patients affected by monolateral Md who were managed with ablation treatment effected with a mixture of gentamicin and human fibrin glue. Upon follow-up examination after one year, all of the patients presented a marked reduction in vestibular reflectivity on the side treated. The vertigo score was zero in all of the patients, showing that the vertigo symptoms were entirely under control. When patients were asked to rate their disability, vertigo was assessed as completely under control in 7 patients and substantially under control in the remaining 3. None of the patients presented any loss of hearing. On the basis of this experience, we propose a standardized protocol which, using an extremely low overall dose of gentamicin, enables elevated success rates to be obtained with the lowest possible number of injections, thus minimizing the risks to hearing. Intratympanic gentamicin associated with a fibrin carrier in Md appears to enable a standardized dose of the drug to be employed, resulting in a decided reduction in the number of administrations and in the overall dose of the drug applied. This makes it possible, with equal benefits in vertigo control, to significantly minimize any hearing loss.
Casani
A P
AP
Dipartimento di Neuroscienze, Sez. ORL, Università di Pisa. mailto:acasani@leonet.it
Dallan
I
I
Sellari-Franceschini
S
S
Nuti
D
D
D000287:Administration, Topical; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D004338:Drug Combinations; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000008:administration & dosage / Q000627:therapeutic use*; D005839:Gentamicins / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008575:Meniere Disease / Q000188:drug therapy*; D008875:Middle Aged
D000900:Anti-Bacterial Agents; D004338:Drug Combinations; D015718:Fibrin Tissue Adhesive; D005839:Gentamicins