Martin Eduardo, Perez Nicolas
Department of Otolaryngology, Hospital Casa de Salud, Valencia, Spain.
Otol Neurotol. 2003 Sep;24(5):800-6. doi: 10.1097/00129492-200309000-00018.
This study set out to evaluate the hearing changes that occur during intratympanic gentamicin therapy and to correlate them with the long-term effects of the treatment on the control of vertigo and on hearing.
This was a prospective study.
Tertiary medical center.
The 71 patients included in the study had been diagnosed with unilateral Ménière's Disease as defined within the 1995 American Academy of Otolaryngology-Head and Neck Surgery guidelines, and had been refractory to medical treatment for at least 1 year.
Intratympanic injections of gentamicin at a concentration of 27 mg/ml were performed at weekly intervals until indications of vestibular hypofunction appeared in the treated ear. If there was a recurrence of the episodes of vertigo, an additional course of injections was performed.
The 1995 American Academy of Otolaryngology-Head and Neck Surgery criteria for reporting the treatment outcome for Ménière's Disease were used. During the period of gentamicin instillation, weekly audiograms were obtained. The results of the treatment were expressed in terms of control of vertigo and hearing level.
Vertigo was controlled by gentamicin instillation in 83.1% of the 71 patients. Two years after the treatment, hearing loss as a result of the gentamicin injections was observed in only 11 (15.5%) patients. The recurrence of spells of vertigo after having initially achieved complete control was noted in 17 (23.9%) patients. Hearing loss at the end of the treatment occurred in 32.4% of the patients, but it was transitory so that 3 months after ending the treatment it was 12.7% and after 2 years it was 15.5%. Those patients in whom no change in their level of hearing occurred during the treatment needed another course of injections and presented poorer overall control of vertigo.
Ending weekly intratympanic injections when clinical signs of vestibular deafferentation appear results in the control of vertigo in the majority of patients. The hearing changes detected during the treatment are transitory and are the only clinical sign that predicts the response to gentamicin instillation.
本研究旨在评估鼓室内注射庆大霉素治疗期间发生的听力变化，并将其与该治疗对眩晕控制和听力的长期影响相关联。
这是一项前瞻性研究。
三级医疗中心。
纳入研究的71例患者已根据1995年美国耳鼻咽喉头颈外科学会指南被诊断为单侧梅尼埃病，并且对药物治疗至少1年无效。
每周进行一次鼓室内注射浓度为27mg/ml的庆大霉素，直至治疗耳出现前庭功能减退迹象。如果眩晕发作复发，则进行额外疗程的注射。
采用1995年美国耳鼻咽喉头颈外科学会报告梅尼埃病治疗结果的标准。在庆大霉素滴注期间，每周进行听力图检查。治疗结果以眩晕控制和听力水平表示。
71例患者中，83.1%的患者眩晕通过庆大霉素滴注得到控制。治疗两年后，仅11例（15.5%）患者因庆大霉素注射出现听力损失。最初实现完全控制后，17例（23.9%）患者出现眩晕发作复发。治疗结束时，32.4%的患者出现听力损失，但为暂时性，治疗结束3个月后为12.7%，2年后为15.5%。治疗期间听力水平无变化的患者需要进行另一疗程的注射，且眩晕总体控制较差。
当前庭传入神经阻滞的临床体征出现时停止每周鼓室内注射，可使大多数患者的眩晕得到控制。治疗期间检测到的听力变化是暂时的，并且是预测对庆大霉素滴注反应的唯一临床体征。
