Intratympanic gentamicin for Meniere's disease: short- and long-term follow-up of two regimens of treatment.
OBJECTIVE
(1) To compare the results of the 2 regimens of treatment at 2-year follow-up and (2) to evaluate the need and the efficacy of retreatment after the recurrence of vertigo attacks in a longer period of follow-up (using the Kaplan-Meier method of analysis).


METHODS
Retrospective chart review.


METHODS
Tertiary referral center.


METHODS
We analyzed 77 patients treated with intratympanic gentamicin (ITG). Thirty-five patients were treated with high-dose (HD) ITG (in total 6 injections, twice a day, repeated every 3 days) and 42 with low-dose (LD) ITG (1-2 injections). The results of treatment were evaluated in terms of functional level scale, control of vertigo, and hearing impairment.


RESULTS
At 2-year follow-up, a similar percentage of vertigo control was obtained in the 2 groups; the incidence of hearing loss and posttreatment disequilibrium was significantly higher in patients treated with HD-ITG. The long-term follow-up showed a control of vertigo attacks with a single round of treatment in 71.4% of patients treated with HD-ITG and in 55% of those treated with LD-ITG. With repeated rounds, an effective control of vertigo could be achieved in 88.5% using a HD-ITG protocol and 97.7% using a LD-ITG protocol.


CONCLUSIONS
LD-ITG allows obtaining good results in term of vertigo attacks associated with a limited occurrence of side effects. The long-term follow-up showed that LD-ITG needed repeated rounds more frequently than the HD-protocol. HD-ITG ran less risk of needing repeated rounds, but retreatment was ineffective in 40% of the cases requiring surgical therapy.
Department of Surgery and Medicine, Otorhinolaryngology Unit, Pisa University Hospital, Pisa, Italy.
Augusto P
AP
Casani
Niccolò
N
Cerchiai
Elena
E
Navari
Iacopo
I
Dallan
Paolo
P
Piaggi
Stefano
S
Sellari-Franceschini
D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D005839:Gentamicins / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008575:Meniere Disease / Q000188:drug therapy*; D008875:Middle Aged; D016896:Treatment Outcome; D014432:Tympanic Membrane
D000900:Anti-Bacterial Agents; D005839:Gentamicins
Ménière’s disease; dizziness; gentamicin; intratympanic; vertigo