title: Vestibular results after intratympanic gentamicin therapy in disabling Menière's disease.
abstract: Intratympanic injection of gentamicin is increasingly used in the treatment of unilateral disabling Menière's disease (MD). Several objective functional and subjective tests have been developed to assess the control of vertigo after gentamicin treatment. The aim of this study was to show that subjective results require a vestibular deafferentation as profound as possible, evidenced with multifrequency vestibular assessment. Sixty four patients with intractable MD in situation of medical treatment failure longer than 6 months were included between 1998 and 2013 in this case control study. A 2-year follow-up was performed after the last intratympanic gentamicin performed with the titration technique. A vestibular assessment was applied before and after 2 years of treatment with a functional level score using the AAOHNS vertigo scale and multifrequency vestibular assessment: skull vibration-induced nystagmus test (SVINT), head-shaking test (HST) and caloric test (CaTe). The correlation between the results of the questionnaire and the level of the deafferentation as evaluated by the tests was analyzed with the Spearman test. Among the 64 included patients, 56 (87.5 %) described vertigo control. There was a correlation (=-0.33 [-0.53; -0.09], p = 0.008) between subjective improvement (AAO -HNS 1 or 2) and the degree of vestibular deafferentation as evidenced by a destructive nystagmus (beating toward the safe side) with the HST and the SVINT, as well as a caloric hypofunction >90 % with the CaTe. The present study demonstrates that a profound vestibular deafferentation confirmed with multifrequency test evaluation is needed to have a subjective improvement in the treatment of unilateral disabling MD with intratympanic gentamicin.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Grenoble, Grenoble, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Junet
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Saint-Etienne, Saint-Etienne, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Karkas
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Grenoble, Grenoble, France.
authors.forename: Georges
authors.initials: G
authors.lastname: Dumas
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Grenoble, Grenoble, France.
authors.forename: Jean Louis
authors.initials: JL
authors.lastname: Quesada
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Grenoble, Grenoble, France. SSchmerber@chu-grenoble.fr.|Department of Oto-Rhino-Laryngology, University Hospital of Grenoble, CHU A. Michallon, BP 217, 38043, Grenoble cedex 09, France. SSchmerber@chu-grenoble.fr.
authors.forename: Sébastien
authors.identifier: http://orcid.org/0000-0003-0189-5574
authors.initials: S
authors.lastname: Schmerber
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D016022:Case-Control Studies; D005260:Female; D005839:Gentamicins / Q000008:administration & dosage*; D006801:Humans; D000069555:Injection, Intratympanic; D008297:Male; D008575:Meniere Disease / Q000188:drug therapy* / Q000503:physiopathology; D008875:Middle Aged; D016896:Treatment Outcome; D014722:Vestibule, Labyrinth / Q000187:drug effects / Q000503:physiopathology*
chemical_list: D000900:Anti-Bacterial Agents; D005839:Gentamicins
keywords: Chemical labyrinthectomy; Intratympanic gentamicin; Menière’s disease; Skull vibration-induced nystagmus test; Titration technique