title: Management of intractable Ménière's disease after intratympanic injection of gentamicin.
abstract: OBJECTIVE
  1) To evaluate the efficacy of, and problems with, intratympanic gentamicin injection (ITG) in medically intractable definite Ménière's disease (MD) and secondary endolymphatic hydrops (EH); and 2) to review the vestibular status and treatment options of intractable vertigo even after ITG.
  
  
  METHODS
  Retrospective case review and survey.
  
  
  METHODS
  780 patients with definite MD and secondary EH were enrolled. Long-term outcomes and problems of applied treatment options including ITG and exploratory tympanotomy and gentamicin application (ETG) were analyzed.
  
  
  RESULTS
  Of the 780 patients, 95 patients received ITG. Class A and B control of vertigo was achieved in 85 (89.5%) patients; two patients were class C and eight patients were class F (ETG: 6; labyrinthectomy: 1; vestibular neurectomy: 1). Among seven patients who received ETG including 1 patient who skipped ITG due to chronic otitis media, five patients improved to class A, showing a 71.4% success rate; and labyrinthectomies were performed subsequently in the two remaining patients. Vertigo was controlled (class A) in all the patients who received labyrinthectomies (n = 4) or vestibular neurectomy (n = 1). Eight patients (8.4%) experienced more than 10 dB worsening, and two patients (2.1%) progressed to bilateral Ménière's disease.
  
  
  CONCLUSIONS
  ITG failed to control vertigo in 10.5% of cases. ETG may be a reasonable option to facilitate the delivery of gentamicin into the inner ear by direct application of gentamicin over the round window and the oval window. Labyrinthectomy and vestibular neurectomy still have roles in the era of ITG.
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea.
authors.forename: Yoon C
authors.initials: YC
authors.lastname: Rah
authors.forename: Jae J
authors.initials: JJ
authors.lastname: Han
authors.forename: Jaehong
authors.initials: J
authors.lastname: Park
authors.forename: Byung Y
authors.initials: BY
authors.lastname: Choi
authors.forename: Ja-Won
authors.initials: JW
authors.lastname: Koo
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D018159:Endolymphatic Hydrops / Q000175:diagnosis / Q000188:drug therapy; D005260:Female; D005500:Follow-Up Studies; D005839:Gentamicins / Q000008:administration & dosage* / Q000009:adverse effects; D006320:Hearing Tests; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D008575:Meniere Disease / Q000175:diagnosis* / Q000188:drug therapy*; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014432:Tympanic Membrane / Q000187:drug effects*; D014717:Vertigo / Q000453:epidemiology / Q000503:physiopathology
chemical_list: D005839:Gentamicins
keywords: Gentamicin; Ménière's disease; intratympanic injection; vertigo