title: Intratympanic treatment of intractable unilateral Meniere disease: gentamicin or dexamethasone? A randomized controlled trial.
abstract: OBJECTIVE
  To determine the efficacy and safety of low-dose intratympanic gentamicin (ITG) compared with intratympanic dexamethasone (ITD) in patients with intractable unilateral Ménière disease (MD).
  
  
  METHODS
  Open prospective randomized controlled study.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  Sixty patients affected by definite unilateral MD were enrolled between January 1, 2007, and June 30, 2008. Thirty-two patients were treated with a buffered gentamicin solution injected in the middle ear (maximum of 2 injections); 28 patients were treated with ITD (4 mg/mL, 3 injections at intervals of 1 every 3 days). Mean outcome measurements consisted of control of vertigo attacks, pure tone average (PTA), speech discrimination score, functional disability score, and statistical analysis using repeated measures analysis of variance.
  
  
  RESULTS
  In the ITG group at 2-year follow-up, complete control of vertigo (class A) was achieved in 26 patients (81%) and substantial control of vertigo (class B) in 4 patients (12.5%). In the ITD group, class A was achieved in 12 (43%), and class B in 5 (18%) patients. In the gentamicin group, 4 patients showed a reduction in PTA of ≥10 dB. In the ITD group, PTA was unchanged or slightly improved in 16 patients (belonging to class A-B) and worse in 12.
  
  
  CONCLUSIONS
  Low-dose ITG achieved better outcome than ITD in the control of vertigo attacks in patients suffering from unilateral MD, with a very low incidence of hearing deterioration. ITD offers poorer vertigo control rate, and hearing preservation is achieved only in cases with no vertigo recurrences.
authors.affiliation: Department of Neurosciences, Otorhinolaryngology Unit, Pisa University Hospital, Pisa, Italy. a.casani@med.unipi.it
authors.forename: Augusto Pietro
authors.initials: AP
authors.lastname: Casani
authors.forename: Paolo
authors.initials: P
authors.lastname: Piaggi
authors.forename: Niccolò
authors.initials: N
authors.lastname: Cerchiai
authors.forename: Veronica
authors.initials: V
authors.lastname: Seccia
authors.forename: Stefano Sellari
authors.initials: SS
authors.lastname: Franceschini
authors.forename: Iacopo
authors.initials: I
authors.lastname: Dallan
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D003907:Dexamethasone / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D005839:Gentamicins / Q000008:administration & dosage*; D006320:Hearing Tests; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D008575:Meniere Disease / Q000175:diagnosis* / Q000188:drug therapy*; D008875:Middle Aged; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014432:Tympanic Membrane / Q000187:drug effects*
chemical_list: D005839:Gentamicins; D003907:Dexamethasone