Vestibular results after intratympanic gentamicin therapy in disabling Menière’s disease

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• 作者：Philippe Junet ; Alexandre Karkas…
• 关键词：Menière’s disease ; Intratympanic gentamicin ; Titration technique ; Skull vibration ; induced nystagmus test ; Chemical labyrinthectomy
• 刊名：European Archives of Oto-Rhino-Laryngology
• 出版年：2016
• 出版时间：October 2016
• 年：2016
• 卷：273
• 期：10
• 页码：3011-3018
• 全文大小：507 KB
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Otorhinolaryngology
  Neurosurgery
  Head and Neck Surgery
  
• 出版者：Springer Berlin / Heidelberg
• ISSN：1434-4726
• 卷排序：273

文摘

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.