Time course of repeated intratympanic gentamicin for Ménière's disease.
OBJECTIVE
With low-dose and titration protocols, subsequent intratympanic (IT) gentamicin injections are frequently necessary for vertigo control in Ménière's disease. To date, studies have not provided detailed descriptions of the time course of recurrent vertigo and repeated injections. Our objective is to provide such a description with a Kaplan-Meier survival analysis, which may enable accurate predictions of the probability of recurrent vertigo after a given time or number of injections.


METHODS
Injections of IT gentamicin were administered for unilateral definite Ménière's disease. One injection (or rarely more) in a 6-week period constituted a "round." Repeat rounds were given when needed for control of recurrent vertigo.


METHODS
We used a Kaplan-Meier method to quantify percentages of patients with control of vertigo over an 8-year period. A separate curve was created for each number of rounds, and failure for each was defined as the need for an additional round.


RESULTS
Of 78 patients, 75 (96%) achieved sufficient vertigo control to avoid ablative surgery, and 42 (54%) required only one round. Thirty-six (46%) required multiple rounds. The probability of needing another round increased with each subsequent one, through four rounds. The median times to the next round after one, two, or three rounds were 148, 118, and 124 days, respectively.


CONCLUSIONS
More than half of patients need only one round of IT gentamicin injections. With each additional round through the fourth one, the probability of additional rounds increases. Nevertheless, the majority (96%) of patients do not need ablative surgery after IT gentamicin.
Nguyen
Kimanh D
KD
Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287-0910, USA.
Minor
Lloyd B
LB
Della Santina
Charles C
CC
Carey
John P
JP
D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D018572:Disease-Free Survival; D004334:Drug Administration Schedule; D005839:Gentamicins / Q000008:administration & dosage*; D006801:Humans; D007267:Injections; D053208:Kaplan-Meier Estimate; D008575:Meniere Disease / Q000188:drug therapy*; D055502:Secondary Prevention; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D005839:Gentamicins