title: Treatment of Ménière's disease with "on-demand" intratympanic gentamicin injections.
abstract: OBJECTIVE
  To determine the clinical response to intratympanic administration of gentamicin in patients with Ménière's disease and to ascertain whether the pure-tone average, caloric test, or disease duration might predict clinical control.
  
  
  METHODS
  Prospective study. Patients were followed for at least 2 years after the first injection (mean follow up time, 39 mo), and a Kaplan-Meier analysis was used to determine the survival curve that best explains the response to treatment.
  
  
  METHODS
  Tertiary center, University hospital.
  
  
  METHODS
  Individuals diagnosed with unilateral Ménière's disease that did not respond to previous medical treatment and who had not previously undergone surgery. Of the initial 83 patients recruited, 9 were lost during the follow-up, and thus, 74 subjects were included in the study.
  
  
  METHODS
  In the consultant's surgery, a myringotomy was performed with topic administration of phenol before the intratympanic administration of 2 to 3 ml of gentamicin (26.7 mg/ml). Further injections were administered if vertigo was not controlled and recurred.
  
  
  METHODS
  Absence of vertigo and the need for subsequent injections as measured in using a Kaplan-Meier time-to-event process. To test predictive variables, the log-rank test was used.
  
  
  RESULTS
  Complete control of vertigo was obtained with a single injection of gentamicin in 53% of the patients. Subsequent injections offered a 50% chance of obtaining complete control. Better results were obtained in patients in whom disease duration was less than 3 years.
  
  
  CONCLUSIONS
  On-demand administration of intratympanic gentamicin provides an alternative treatment for medically refractory Ménière's disease. Moreover, the Kaplan-Meier analysis was useful to analyze recurrent manifestations, such as vertigo attacks in Ménière's disease.
authors.affiliation: Department of Otorhinolaryngology, Clínica Universidad de Navarra, University Hospital and Medical School, University of Navarra, Navarra, Spain.
authors.forename: Raquel
authors.initials: R
authors.lastname: Manrique-Huarte
authors.forename: Francisco
authors.initials: F
authors.lastname: Guillén-Grima
authors.forename: Nicolas
authors.initials: N
authors.lastname: Perez-Fernandez
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D004334:Drug Administration Schedule; D005260:Female; D005839:Gentamicins / Q000008:administration & dosage* / Q000627:therapeutic use; D006801:Humans; D007267:Injections; D008297:Male; D008575:Meniere Disease / Q000188:drug therapy*; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome; D014432:Tympanic Membrane
chemical_list: D000900:Anti-Bacterial Agents; D005839:Gentamicins