Intratympanic gentamicin treatment after endolymphatic sac surgery.
CONCLUSIONS
Interval treatment with up to three intratympanic gentamicin injections once weekly effectively controlled vertigo while preserving hearing in patients with Ménière's disease and recurrent or resistant vertigo after saccotomy.


OBJECTIVE
Recurrent or resistant incapacitating vertigo may occur after endolymphatic sac surgery (saccotomy) in patients with Ménière's disease. In these patients, revision saccotomy, vestibular nerve section or labyrinthectomy are the established treatment options. We advocate a once-weekly application of intratympanic gentamicin (12 mg) as an effective alternative in this group of patients.


METHODS
Five patients (age range 39-65 years) with definite Ménière's disease according to the 1995 American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) criteria and incapacitating vertigo underwent gentamicin treatment after saccotomy. Control of vertigo and hearing preservation were the aims of treatment. The follow-up period ranged from 26 to 59 months. History and pure-tone audiometry were used to assess vertigo control and hearing, respectively. The frequency of vertigo in the 6-month period before gentamicin treatment ranged between 0.5 and four definitive episodes per month. Hearing stage (AAO-HNS criteria) before gentamicin treatment ranged between 2 and 4. Pre- and post-treatment pure-tone hearing thresholds at 0.5, 1, 2 and 3 kHz were compared by means of the Mann-Whitney U-test.


RESULTS
Complete vertigo control (class A; AAO-HNS) and hearing preservation at 0.5, 1, 2 and 3 kHz were achieved.
Gouveris
Haralampos
H
Department of Otolaryngology--Head and Neck Surgery, University of Mainz Medical School, Mainz, Germany. gouveris@hno.klinik.uni-mainz.de
Lange
Gert
G
Mann
Wolf J
WJ
D000328:Adult; D000368:Aged; D001301:Audiometry, Pure-Tone; D001309:Auditory Threshold / Q000187:drug effects; D004432:Ear, Middle / Q000187:drug effects; D004584:Electronystagmography / Q000187:drug effects; D018159:Endolymphatic Hydrops / Q000601:surgery*; D004712:Endolymphatic Sac / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005839:Gentamicins / Q000008:administration & dosage*; D006801:Humans; D007267:Injections; D008297:Male; D008575:Meniere Disease / Q000601:surgery*; D008875:Middle Aged; D011183:Postoperative Complications / Q000188:drug therapy*; D012008:Recurrence; D014717:Vertigo / Q000188:drug therapy*
D005839:Gentamicins