Quaranta A, Aloisi A, De Benedittis G, Scaringi A
Department of Ophthalmology and Otorhinolaryngology, University of Bari, Italy.
Ann N Y Acad Sci. 1999 Nov 28;884:410-24. doi: 10.1111/j.1749-6632.1999.tb08658.x.
Many therapeutic options exist for the management of patients with Ménière's disease. In the last few years, the use of intratympanic gentamicin has been investigated as an alternative treatment to vestibular nerve section or labyrinthectomy. In humans, the concentration of gentamicin used for intratympanic treatment of vertigo ranges from 10 mg/mL to 40 mg/mL, and the number of doses from 2 to 14, with a total administered amount between 6 and 2.400 mg. Here lower doses of gentamicin were used, usually had the lowest incidence of hearing loss, but more injections were needed to ablate vestibular function. The purpose of this study was to evaluate the acute and chronic ototoxic effects of intratympanic high-concentration gentamicin after having obliterated the round-window niche with connective tissue in 11 subjects' ears with Ménière's disease. Intratympanic gentamicin was administered according to a predetermined and fixed schedule consisting of two doses of 0.5 mL gentamicin solution, injected once a week with a drug concentration of 80 mg/mL. The total dose of gentamicin was < or = 80 mg. The charts of the patients were surveyed in accordance with the 1995 AAO-HNS guidelines. Three patients had recurrence of vertigo between 3 and 6 months after the second injection and went on to one additional dose of gentamicin. At 2 years follow-up, 10 patients (91%) had complete and 1 (9%) substantial control of vertigo; 3 subjects (27%) had hearing decreased. Tinnitus disappeared or decreased in 3 patients (27%); eight subjects (73%) reported their aural pressure abolished or decreased. The present study demonstrates that in patients with Ménière's disease, 0.5 mL gentamicin solution, with a concentration of 80 mg/mL (total dose < or = 80 mg), injected intratympanically once a week after having obliterated the round-window niche, permits complete or substantial control of vertigo in two-thirds of cases after two doses and in all subjects after three doses. This vertigo control rate is compared to that observed after vestibular nerve section. Hearing results are not different from those with natural control, with endolymphatic sac surgery, and with vestibular nerve section.
梅尼埃病患者的治疗有多种选择。在过去几年中，鼓室内注射庆大霉素作为前庭神经切断术或迷路切除术的替代治疗方法已得到研究。在人体中，用于鼓室内治疗眩晕的庆大霉素浓度范围为10mg/mL至40mg/mL，剂量次数为2至14次，总给药量在6至2400mg之间。这里使用较低剂量的庆大霉素，通常听力损失发生率最低，但需要更多次注射来消除前庭功能。本研究的目的是评估在11例梅尼埃病患者的耳内用结缔组织封闭圆窗龛后，鼓室内注射高浓度庆大霉素的急性和慢性耳毒性作用。鼓室内注射庆大霉素按照预定的固定方案进行，包括两剂0.5mL庆大霉素溶液，每周注射一次，药物浓度为80mg/mL。庆大霉素的总剂量≤80mg。根据1995年美国耳鼻咽喉头颈外科学会（AAO-HNS）指南对患者病历进行调查。3例患者在第二次注射后3至6个月出现眩晕复发，随后又接受了一剂庆大霉素。在2年随访时，10例患者（91%）眩晕得到完全控制，1例（9%）得到有效控制；3例受试者（27%）听力下降。3例患者（27%）耳鸣消失或减轻；8例受试者（73%）报告耳内压力消失或减轻。本研究表明，对于梅尼埃病患者，在封闭圆窗龛后每周一次鼓室内注射0.5mL浓度为80mg/mL的庆大霉素溶液（总剂量≤80mg），三分之二的病例在两剂后、所有受试者在三剂后眩晕可得到完全或有效控制。该眩晕控制率与前庭神经切断术后观察到的结果进行了比较。听力结果与自然病程对照、内淋巴囊手术及前庭神经切断术的结果无差异。
