title: Refractory episodic vertigo: role of intratympanic gentamicin and vestibular evoked myogenic potentials.
abstract: BACKGROUND
  Even today, the treatment of intractable vertigo remains a challenge. Vestibular ablation with intratympanic gentamicin stands as a good alternative in the management of refractory vertigo patients.
  
  
  OBJECTIVE
  To control intractable vertigo through complete saccular and horizontal canal vestibular ablation with intratympanic gentamicin treatment.
  
  
  METHODS
  Patients with refractory episodic vertigo were included. The inclusion criteria were: unilateral ear disease, moderate to profound sensorineural hearing loss, and failure to other treatments. Included patients underwent 0.5-0.8mL of gentamicin intratympanic application at a 30mg/mL concentration. Vestibular ablation was confirmed by the absence of response on cervical vestibular evoked myogenic potentials and no response on caloric tests. Audiometry, electronystagmography with iced water, and vestibular evoked myogenic potentials were performed in all patients.
  
  
  RESULTS
  Ten patients were included; nine patients with Meniere's disease and one patient with (late onset) delayed hydrops. Nine patients showed an absent response on vestibular evoked myogenic potentials and no response on caloric tests. The only patient with low amplitude on cervical vestibular evoked myogenic potentials had vertigo recurrence. Vertigo control was achieved in 90% of the patients. One patient developed hearing loss >30dB.
  
  
  CONCLUSIONS
  Cervical vestibular evoked myogenic potentials confirmed vestibular ablation in patients treated with intratympanic gentamicin. High-grade vertigo control was due to complete saccular and horizontal canal ablation (no response to iced water in electronystagmography and no response on cervical vestibular evoked myogenic potentials).
authors.affiliation: Universidad Autónoma de Sinaloa, Centro de Investigación y Docencia en Ciencias de la Salud (CIDOCS), Departamento de Otorrinolaringología, Culiacán, Sinaloa, Mexico. Electronic address: erikacelis@hotmail.com.
authors.forename: Erika
authors.initials: E
authors.lastname: Celis-Aguilar
authors.affiliation: Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Department of Neurotology, Ciudad de México, Mexico.
authors.forename: Ramon
authors.initials: R
authors.lastname: Hinojosa-González
authors.affiliation: Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Department of Neurotology, Ciudad de México, Mexico.
authors.forename: Olivia
authors.initials: O
authors.lastname: Vales-Hidalgo
authors.affiliation: Hospital Médica Sur, Ciudad de México, Mexico.
authors.forename: Heloisa
authors.initials: H
authors.lastname: Coutinho-Toledo
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002150:Caloric Tests; D004584:Electronystagmography; D005260:Female; D005839:Gentamicins / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008575:Meniere Disease / Q000188:drug therapy*; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014432:Tympanic Membrane; D058585:Vestibular Evoked Myogenic Potentials / Q000187:drug effects*
chemical_list: D000900:Anti-Bacterial Agents; D005839:Gentamicins
keywords: Doença de Ménière; Gentamicina intratimpânica; Intratympanic gentamicin; Meniere disease; Potencial evocado miogênico vestibular; Refractory vertigo; Vertigem refratária; Vestibular evoked myogenic potentials