title: Single intratympanic gentamicin injection in Ménière's disease: VOR change and prognostic usefulness.
abstract: OBJECTIVE
  Assess angular vestibular-ocular reflex (VOR) changes after treatment with intratympanic gentamicin (ITG) for Ménière's disease (MD) and impact on short-term follow-up.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  Patients submitted to ITG for unilateral MD. The gain VOR and the presence of compensatory saccades elicited by rapid head impulses were measured using the video head impulse test (vHIT).
  
  
  RESULTS
  The study included 31 subjects (mean age: 59 years). Functional Level Scale (FLS) distributions were 35,5% (FLS3); 32,2% (FLS4); and 32,2% (FLS5). Mean follow-up was 21 ± 7 months. Multiple injections were needed in nine patients. VOR gain in the treated ear was significantly reduced in all subjects and for all the semicircular canals (paired samples t test; P < 0,05). Gain averages after treatment were 0,61 (superior); 0,69 (horizontal); and 0,47 (posterior). A horizontal canal VOR gain superior to 0,80 after treatment was associated with the need for a second gentamicin injection (Chi-square; P = 0,003). Gain asymmetry between the symptomatic and asymptomatic ear (GASM) was increased after treatment. The rate of vestibular function reduction was 47,9%; 26,0%; and 35,8% for the superior, horizontal, and posterior canals, respectively. According to the receiving operator characteristic curve, the amount of change in GASM must be greater than 7 in order to predict the avoidance of a second procedure (area under the curve [AUC] horizontal canal = 0,861) and the amount of vestibular function reduction in the pathologic ear in patients with a controlled disease must be greater than 17,8% (AUC horizontal canal = 0,843).
  
  
  CONCLUSIONS
  When evaluated with the vHIT, intratympanic gentamicin changes in VOR seem to foresee short-term control of vertigo attacks.
  
  
  METHODS
  4.
authors: Department of Otorhinolarygology-Centro Hospitalar São João EPE, Porto, Portugal.|Department of Otorhinolaryngology-University of Oporto Medical School, Porto, Portugal.
authors: Pedro
authors: P
authors: Marques
authors: Department of Otorhinolaryngology-Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain.
authors: Raquel
authors: R
authors: Manrique-Huarte
authors: Department of Otorhinolaryngology-Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain.
authors: Nicolas
authors: N
authors: Perez-Fernandez
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D005839:Gentamicins / Q000008:administration & dosage*; D006801:Humans; D007267:Injections; D008297:Male; D008575:Meniere Disease / Q000188:drug therapy* / Q000503:physiopathology; D008875:Middle Aged; D011446:Prospective Studies; D012027:Reflex, Vestibulo-Ocular / Q000502:physiology*; D013997:Time Factors; D016896:Treatment Outcome; D014432:Tympanic Membrane; D014722:Vestibule, Labyrinth / Q000503:physiopathology*
chemical_list: D000900:Anti-Bacterial Agents; D005839:Gentamicins
keywords: Dizziness; Ménière's; inner ear; video head-impulse