title: Variability in the perilymphatic diffusion of gadolinium does not predict the outcome of intratympanic gentamicin in patients with Ménière's disease.
abstract: OBJECTIVE
  To assess the utility of imaging in planning intratympanic (IT) gentamicin (Gent) treatment in Ménière's disease (MD), we compared the dosage and outcomes of ITGent with the severity and extent of endolymphatic hydrops (EH), as evaluated by three-dimensional fluid-attenuated inversion recovery (3D-FLAIR) sequence in a 3-T magnetic resonance imaging (MRI) unit, after IT gadolinium administration.
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  A total of 18 patients (10 males and 8 females; age, 28-78 years; median age, 53.2 years) with definite MD participated in the investigation. The duration of the disease ranged from 8 months to 9 years (median, 2 years), with a prevalence of vertigo spells ranging from 0.8 to 8 per month (median, 2.2), as calculated in the last 6 months. A 3D-FLAIR MRI was performed 24 hours after IT injection of diluted gadobutrol. ITGent injection was performed within a variable period of time, from 1 week to 3 weeks after 3D-FLAIR MRI. The degree and extension of EH as evaluated by 3D-FLAIR MRI were compared with the number of injections necessary to cure vertigo attacks. Vertigo results, functional level scale modifications, variations in caloric excitability, and pure-tone average modifications.
  
  
  RESULTS
  No statistically significant correlation was observed between severity of EH and outcomes of ITGent administration.
  
  
  CONCLUSIONS
  The hypothesis of a reduced effect of Gent administered intratympanically in the presence of severe EH, owing to obstacled diffusion along the perilymphatic compartments, has not been confirmed in the present investigation.
authors.affiliation: Department of Otolaryngology, General Hospital, Verona, Italy. franco.fiorino@virgilio.it
authors.forename: Francesco
authors.initials: F
authors.lastname: Fiorino
authors.forename: Francesca B
authors.initials: FB
authors.lastname: Pizzini
authors.forename: Franco
authors.initials: F
authors.lastname: Barbieri
authors.forename: Alberto
authors.initials: A
authors.lastname: Beltramello
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D003287:Contrast Media / Q000493:pharmacokinetics; D004710:Endolymph / Q000378:metabolism*; D005260:Female; D005500:Follow-Up Studies; D019786:Gadolinium DTPA / Q000493:pharmacokinetics; D005839:Gentamicins / Q000008:administration & dosage* / Q000627:therapeutic use; D006801:Humans; D021621:Imaging, Three-Dimensional; D007267:Injections; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008575:Meniere Disease / Q000175:diagnosis* / Q000188:drug therapy / Q000378:metabolism; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D014432:Tympanic Membrane
chemical_list: D000900:Anti-Bacterial Agents; D003287:Contrast Media; D005839:Gentamicins; D019786:Gadolinium DTPA