Sala T
Department of Otorhinolaryngology, Hospital of Piove di Sacco, Piove di Sacco, PD, Italy.
Acta Otorhinolaryngol Ital. 2003 Apr;23(2):78-87.
Treatment of Menière's disease is aimed at restoring a normal quality of life and preserving residual hearing, in view of the increasing frequency with which the contralateral ear is affected. Conventional medical treatment (diuretics + vasoactive drugs) leads to cure in a large percentage of patients (75-95%). In intractable cases, transtympanic (intratympanic) aminoglycoside therapy, associated with various techniques, is becoming widespread as an alternative to surgery. Progressive reduction of the dose introduced into the middle ear did not prevent the onset of anacusis in several patients; the variable, unpredictable permeability of the round window membrane, the object of fundamental studies in the past, explains this complication. The Author has used gentamicin transtympanically in Menierians since 1978, and has treated a total of 105 patients. He first prescribed transtympanic gentamicin therapy that did not follow, but was integrated with conventional medical treatment in 22 intractable Menierians, by instilling the minimum effective dose, to reduce the risk of hearing impairment. Preliminary results, related to stage of disease, may be summarised as follows: improvement in the quality of life, as evaluated by the American Academy of Ophthalmology & Otolaryngology Committee on Hearing and Equilibrium questionnaire (14 patients--63.63%--at point 1 and 8-36.36%--at point 2); disappearance of vertigo in 15 patients (68.18%); a minor vertigo attack in 3 and two minor attacks in 3 others not affecting quality of life; persistence of occasional unsteadiness in one patient. Hearing remained unchanged in 15 patients, improved slightly in 3 cases and worsened slightly in 2; decreased sensitivity to high tones was observed in 2 patients at the first insertion of gentamicin. According to the Author, employing integrated therapy and using the minimum effective dose of gentamicin, the risk of damage to the cochlear structures may be reduced, although not excluded, while restoring a good quality of life, even when repeat instillation is necessary.
鉴于对侧耳受累频率增加，梅尼埃病的治疗旨在恢复正常生活质量并保留残余听力。传统药物治疗（利尿剂+血管活性药物）可使大部分患者（75-95%）治愈。在难治性病例中，经鼓室（鼓室内）氨基糖苷类药物治疗结合各种技术，作为手术的替代方法正变得越来越普遍。向中耳引入的剂量逐渐减少并不能防止一些患者出现全聋；圆窗膜可变、不可预测的通透性是过去基础研究的对象，这解释了这种并发症。作者自1978年以来一直在梅尼埃病患者中经鼓室使用庆大霉素，共治疗了105例患者。他首先为22例难治性梅尼埃病患者开了经鼓室庆大霉素治疗，该治疗并非遵循而是与传统药物治疗相结合，通过滴注最小有效剂量来降低听力损害风险。与疾病阶段相关的初步结果可总结如下：根据美国眼耳鼻喉科医师学会听力与平衡委员会问卷评估，生活质量得到改善（14例患者——第1阶段为63.63%，第2阶段为8 - 36.36%）；15例患者（68.18%）眩晕消失；3例患者有轻微眩晕发作，另外3例有两次轻微发作但不影响生活质量；1例患者偶尔仍有不稳感。15例患者听力保持不变，3例略有改善，2例略有恶化；2例患者在首次滴注庆大霉素时出现对高音调的敏感性下降。据作者称，采用综合治疗并使用庆大霉素的最小有效剂量，虽然不能排除，但可以降低对耳蜗结构的损害风险，同时即使需要重复滴注也能恢复良好的生活质量。
