Outcomes in the use of intra-tympanic gentamicin in the treatment of Ménière's disease

2005 ◽  
Vol 120 (2) ◽  
pp. 98-102 ◽  
Author(s):  
Sean Flanagan ◽  
Payal Mukherjee ◽  
John Tonkin
Keyword(s):  
Hearing Loss ◽  
Endolymphatic Hydrops ◽  
Meniere’S Disease ◽  
Menière’S Disease ◽  
High Rate ◽  
Response To Treatment ◽  
Meniere's Disease ◽  
Ménière’S Disease ◽  
Menière's Disease ◽  
Ménière's Disease

The pathogenesis of Ménière's disease is associated with a disorder of ionic homeostasis, with the pathologic correlate being endolymphatic hydrops. Despite uncertainty as to its particular mode of action, it is accepted wisdom that intra-tympanic gentamicin has a definite therapeutic role in the control of symptoms in patients who fail to respond to medical therapy. This study reports an evaluation of the efficacy of intra-tympanic gentamicin in the treatment of Ménière's disease and also presents a simple, reliable, safe method of administering gentamicin for this purpose.A retrospective review of 56 patients undergoing intra-tympanic gentamicin treatment for Ménière's disease was conducted. Response to treatment was analysed using a patient survey and examination of pure-tone averages. An overall significant improvement in vertigo symptoms of 81.3 per cent was found. There was a 21.4 per cent rate of significant hearing loss, defined as greater than 10 dB, with an average loss in this group of 18.5 dB. A single dose of gentamicin applied directly to the round window resulted in a high rate of control of vertigo, with acceptably low rates of hearing loss.

More drugs for meniere’s disease

1971 ◽  
Vol 9 (11) ◽  
pp. 42-43
Keyword(s):  
Hearing Loss ◽  
Endolymphatic Hydrops ◽  
Meniere’S Disease ◽  
Menière’S Disease ◽  
Meniere's Disease ◽  
Ménière’S Disease ◽  
Menière's Disease ◽  
Ménière's Disease ◽  
Demyelinating Disorders ◽  
Orally Active

Ménière’s syndrome is paroxysmal vertigo with tinnitus and sensorineural (perceptive) hearing loss. The hearing loss may be slowly progressive, fluctuating or sudden. Where no organic cause can be discovered the condition is called Ménière’s disease. The syndrome is found in patients with bone disease involving the otic capsule such as otosclerosis, osteitis deformans or late syphilis. It may also follow labyrinthine trauma or be associated with a wide variety of diseases interfering with the blood supply to the brainstem or inner ear. Endolymphatic hydrops has been demonstrated in all these conditions, and it is believed that it may occur also in Ménière’s disease. Other causes of the syndrome include inflammatory or demyelinating disorders or tumours involving the eighth nerve. Many drugs have been used to treat Ménière’s disease, but with little success. Drugs investigated in recent years include cinnarizine (an antihistamine which has been used for vertigo and motion sickness), betahistine (an orally active histamine analogue) and hydrochlorothiazide.

scholarly journals Cochlear Meniere's: A Distinct Clinical Entity With Isolated Cochlear Hydrops on High-Resolution MRI?

2021 ◽  
Vol 8 ◽  
Author(s):  
Jose E. Alonso ◽  
Gail P. Ishiyama ◽  
Rance J. T. Fujiwara ◽  
Nancy Pham ◽  
Luke Ledbetter ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Endolymphatic Hydrops ◽  
Meniere’S Disease ◽  
Menière’S Disease ◽  
Meniere's Disease ◽  
Ménière’S Disease ◽  
Menière's Disease ◽  
Vestibular Testing ◽  
History Of ◽  
Ménière's Disease

Objective: Describe the clinical characteristics of patients with isolated cochlear endolymphatic hydrops (EH).Study design: Clinical case series.Setting: Tertiary Neurotology referral clinic.Patients: All subjects presenting to a University Neurotology clinic during a 1-year period from July 2015 until August 2016 who had isolated cochlear EH on MRI. Patients with a history of temporal bone surgery prior to the MRI were excluded.Intervention: High-resolution delayed-intravenous contrast MRI.Main outcome measures: Audiometric and vestibular testing, clinical history analysis.Results: 10 subjects demonstrated isolated, unilateral cochlear hydrops on MRI. None of these patients met the criteria for Meniere's disease. Mean age of the group was 66.4 years and most were males (70%). Unilateral aural fullness (70%), tinnitus (80%), and hearing loss (90%) were frequently observed. Only one patient presented with unsteadiness (10%) and one patient had a single isolated spell of positional vertigo 1 month prior to the MRI (10%) but no further vertigo spells in the 4 years following the MRI. The mean PTA was 37.8 dB which was significantly decreased from the non-affected ear with PTA of 17.9 (p < 0.001). One patient developed vertiginous spells and unsteadiness 4 years after initial presentation and a repeat MRI revealed progression to utricular, saccular and cochlear hydrops. Vestibular testing was obtained in five patients with one patient presenting with 50% caloric paresis and all others normal. The most common treatment tried was acetazolamide in seven patients with 86% reporting subjective clinical improvement. Two out of the 10 patients had a history of migraine (20%).Conclusions: Patients with MRI exhibiting isolated cochlear EH present with predominantly auditory symptoms: mild to moderate low-frequency hearing loss, aural fullness, tinnitus without significant vertigo. Isolated cochlear hydrops is more common in males, average age in mid-60's and there is a low comorbidity of migraine headaches. This contrasts significantly with patients with isolated saccular hydrops on MRI from our prior studies. We believe that isolated cochlear EH with hearing loss but no vertigo is distinct from Meniere's disease or its variant delayed endolymphatic hydrops. We propose that cochlear Meniere's disease represents a distinct clinical entity that could be a variant of Meniere's disease.

Menière’s disease

2020 ◽  
pp. practneurol-2020-002734
Author(s):  
Mansur Amirovich Kutlubaev ◽  
Ilmari Pyykko ◽  
Todd A Hardy ◽  
Robert Gürkov
Keyword(s):  
Hearing Loss ◽  
Endolymphatic Hydrops ◽  
Meniere’S Disease ◽  
Menière’S Disease ◽  
Meniere's Disease ◽  
Ménière’S Disease ◽  
Menière's Disease ◽  
Bilateral Vestibulopathy ◽  
Intratympanic Injection ◽  
Ménière's Disease

Menière’s disease causes paroxysmal rotatory vertigo, due to endolymphatic hydrops, an accumulation of endolymph in the endolymphatic space of the labyrinth. Its major symptoms are attacks of rotatory vertigo lasting minutes to hours, with unilateral hearing loss, tinnitus and aural fullness. As the disease progresses, attacks happen less often, but hearing loss and tinnitus gradually become permanent. Neuro-otological complications may develop, such as benign paroxysmal positional vertigo, vestibular drop attacks and bilateral vestibulopathy. The diagnosis of Menière’s disease is based on the typical clinical picture and typical findings on the audiogram. Furthermore, it is now possible to diagnose it by MR of the inner ear. Long-term management has several steps, including diet, diuretics, intratympanic injection of corticosteroid or gentamicin and surgery (endolymphatic sac surgery, grommet insertion, surgical labyrinthectomy).

Rupture-Like Shrinkage and Regrowth of Endolymphatic Hydrops in Ménière's Disease During Remission

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Munehisa Fukushima ◽  
Yu Suekata ◽  
Takuya Kusumoto ◽  
Shiro Akahani ◽  
Hidehiko Okamoto ◽  
...  
Keyword(s):  
Endolymphatic Hydrops ◽  
Meniere’S Disease ◽  
Menière’S Disease ◽  
Meniere's Disease ◽  
Ménière’S Disease ◽  
Menière's Disease ◽  
Ménière's Disease

scholarly journals Good Clinical Approach: Delphi Consensus for the Use of Betahistine in Menière’s Disease

2018 ◽  
Vol 2018 ◽  
pp. 1-11 ◽  
Author(s):  
Augusto Pietro Casani ◽  
Elena Navari ◽  
Giorgio Guidetti ◽  
Michel Lacour
Keyword(s):  
Hearing Loss ◽  
Meniere’S Disease ◽  
Consensus Conference ◽  
Menière’S Disease ◽  
Meniere's Disease ◽  
Ménière’S Disease ◽  
Clinical Approach ◽  
Menière's Disease ◽  
Delphi Consensus ◽  
Ménière's Disease

Menière’s disease is a disorder of the inner ear that causes vertigo, tinnitus, fullness, and hearing loss. Several pharmacological treatments are available, but none of them has shown significant results. Betahistine has been largely used but its effect on the main symptoms of Menière’s disease remains unclear. In order to improve clinical appropriateness and to reduce the heterogeneity of the therapeutic approaches for Menière’s disease, we proposed a European Consensus Conference on Betahistine’s prescription. A group of European experts in vestibular disorders completed a questionnaire, prepared by opinion leaders, on the use of betahistine in Menière’s disease. The Delphi method was used as an iterative investigation method in order to increase and establish the consensus. While betahistine was considered useful to reduce the number of the vertigo attacks during the intercritical phase of the disease, its use during attacks was considered helpful only when associated with other drugs. Betahistine was not considered useful for preventing hearing loss. The experts support the use of betahistine during the intercritical phase of the disease to reduce the number and severity of vertigo episodes. They also defined the parameters for a good clinical approach to evaluate the efficacy of betahistine treatment for Menière’s disease.

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