Middle ear gentamicin-soaked pledgets in the treatment of Ménière's disease.
OBJECTIVE
Assess the relative efficacy and results of the round window hyaluronic acid pledget depot method for intratympanic gentamicin delivery in Ménière's disease.


METHODS
Retrospective case review.


METHODS
Tertiary referral hospital.


METHODS
Prospective symptomatic and audiologic data were collected on 28 patients undergoing intratympanic gentamicin therapy for Ménière's disease refractory to medical treatment between 2003 and 2009.


METHODS
All patients had the round window membrane exposed via a tympanomeatal flap, and any adhesions were removed. Hyaluronic acid pledgets soaked in 40 mg/ml of gentamicin were then packed into the round window niche and posterior mesotympanum, and the tympanomeatal flap was replaced.


METHODS
Patients audiologic and vertigo symptom outcome scores were recorded at follow-up according to the AAO-HNS 1995 guidelines for reporting results in Ménière's disease.


RESULTS
Complete or substantial improvement in vertigo (class A or B) was achieved in 88.5% (23/26) of patients. Hearing loss, defined as greater than 10 dB (PTA average at 0.5, 1, 2, and 4 kHz) was noted in 12 (50%) of 24 patients including 4 patients who had developed "dead ears" (16%). The average hearing loss for all patients excluding the 4 patients with dead ears was 10.7 dB.


CONCLUSIONS
Round window hyaluronic acid pledget technique used as a sustained delivery vehicle for intratympanic gentamicin treatment for Ménière's disease produces similar rates of vertigo control compared with other techniques but a greater risk of hearing loss. We would recommend the intratympanicinjection titration technique as first line for most patients.
*Department of Otolaryngology, John Radcliffe Hospital, Oxford; and †Department of Otolaryngology, Wexham Park Hospital, Slough, West Berkshire, U.K.
Samuel A C
SA
MacKeith
Olivia J H
OJ
Whiteside
Thomas
T
Mawby
Ian D
ID
Bottrill
D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D016503:Drug Delivery Systems; D004432:Ear, Middle / Q000187:drug effects*; D005260:Female; D005839:Gentamicins / Q000008:administration & dosage / Q000627:therapeutic use*; D034381:Hearing Loss / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008575:Meniere Disease / Q000175:diagnosis / Q000188:drug therapy*; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D005839:Gentamicins