Minor L B
Department of Otolaryngology--Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21203, USA.
Am J Otol. 1999 Mar;20(2):209-19.
To determine if a protocol of weekly intratympanic gentamicin injections administered until development of signs of unilateral vestibular hypofunction can alleviate vertigo while preserving hearing in patients with intractable vertigo caused by unilateral Meniere's disease.
The study design was a prospective investigational protocol.
The study was performed in outpatients at a tertiary referral center.
Entry criteria included a diagnosis of "definite" Meniere's disease according to the 1995 report of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS), intractable vertigo despite optimal medical therapy, no symptoms suggestive of Meniere's disease in the contralateral ear and serviceable hearing in the contralateral ear. The outcomes of the first 34 patients who entered the protocol are reported.
A buffered gentamicin solution was injected into the middle ear at weekly intervals until development of spontaneous nystagmus, head-shaking-induced nystagmus, or head-thrust sign indicative of vestibular hypofunction in the treated ear.
The 1995 AAO-HNS criteria for reporting treatment outcome in Meniere's disease were used. The effects of treatment were assessed in terms of control of vertigo, disability status, hearing level, and quantitative measurement of vestibular function with caloric and rotatory chair tests.
Vertigo was controlled in 91% of the patients. Profound hearing loss occurred as a result of gentamicin injection in one patient (3%). Intratympanic gentamicin was significantly less effective in controlling vertigo in patients who had previous otologic surgery on the affected ear. Recurrence of vertigo > or = 6 months after initially complete control was noted in seven patients (22%). Vertigo in six of these patients was eliminated by additional intratympanic gentamicin injections.
Ending weekly intratympanic gentamicin injections when clinical signs of unilateral vestibular hypofunction appear can control vertigo in most patients. Hearing loss directly attributable to gentamicin is uncommon. Treatment outcome is best in patients who have not had previous otologic surgery.
确定一种每周鼓室内注射庆大霉素直至出现单侧前庭功能减退体征的方案，是否能缓解由单侧梅尼埃病引起的顽固性眩晕患者的眩晕症状，同时保留听力。
本研究设计为前瞻性研究方案。
研究在一家三级转诊中心的门诊患者中进行。
入选标准包括根据美国耳鼻咽喉头颈外科学会（AAO - HNS）1995年报告诊断为“明确的”梅尼埃病，尽管接受了最佳药物治疗仍有顽固性眩晕，对侧耳无梅尼埃病症状且对侧耳听力正常。报告了最初进入该方案的34例患者的结果。
将缓冲后的庆大霉素溶液每周注射到中耳，直至在治疗耳出现自发性眼震、摇头诱发眼震或提示前庭功能减退的头脉冲征。
采用1995年AAO - HNS报告梅尼埃病治疗结果的标准。通过眩晕控制情况、残疾状态、听力水平以及用冷热试验和转椅试验对前庭功能进行定量测量来评估治疗效果。
91%的患者眩晕得到控制。1例患者（3%）因注射庆大霉素出现严重听力损失。对于患侧耳曾接受过耳科手术的患者，鼓室内注射庆大霉素在控制眩晕方面效果明显较差。7例患者（22%）在最初完全控制眩晕后6个月或更长时间出现眩晕复发。其中6例患者通过额外的鼓室内注射庆大霉素眩晕得以消除。
当出现单侧前庭功能减退的临床体征时停止每周鼓室内注射庆大霉素，可使大多数患者的眩晕得到控制。直接归因于庆大霉素的听力损失并不常见。未接受过耳科手术的患者治疗效果最佳。
