Gouveris Haralampos, Lange Gert, Mann Wolf J
Department of Otolaryngology--Head and Neck Surgery, University of Mainz Medical School, Mainz, Germany.
Acta Otolaryngol. 2005 Nov;125(11):1180-3. doi: 10.1080/00016480510043909.
Interval treatment with up to three intratympanic gentamicin injections once weekly effectively controlled vertigo while preserving hearing in patients with Ménière's disease and recurrent or resistant vertigo after saccotomy.
Recurrent or resistant incapacitating vertigo may occur after endolymphatic sac surgery (saccotomy) in patients with Ménière's disease. In these patients, revision saccotomy, vestibular nerve section or labyrinthectomy are the established treatment options. We advocate a once-weekly application of intratympanic gentamicin (12 mg) as an effective alternative in this group of patients.
Five patients (age range 39-65 years) with definite Ménière's disease according to the 1995 American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) criteria and incapacitating vertigo underwent gentamicin treatment after saccotomy. Control of vertigo and hearing preservation were the aims of treatment. The follow-up period ranged from 26 to 59 months. History and pure-tone audiometry were used to assess vertigo control and hearing, respectively. The frequency of vertigo in the 6-month period before gentamicin treatment ranged between 0.5 and four definitive episodes per month. Hearing stage (AAO-HNS criteria) before gentamicin treatment ranged between 2 and 4. Pre- and post-treatment pure-tone hearing thresholds at 0.5, 1, 2 and 3 kHz were compared by means of the Mann-Whitney U-test.
Complete vertigo control (class A; AAO-HNS) and hearing preservation at 0.5, 1, 2 and 3 kHz were achieved.
对于梅尼埃病患者以及在进行内淋巴囊切开术后出现复发性或难治性眩晕的患者，每周一次进行多达三次鼓室内庆大霉素注射的间歇性治疗可有效控制眩晕，同时保留听力。
梅尼埃病患者在内淋巴囊手术（内淋巴囊切开术）后可能会出现复发性或难治性致残性眩晕。对于这些患者，再次内淋巴囊切开术、前庭神经切断术或迷路切除术是既定的治疗选择。我们主张在这组患者中每周一次应用鼓室内庆大霉素（12毫克）作为一种有效的替代方法。
五名年龄在39至65岁之间、根据1995年美国耳鼻咽喉头颈外科学会（AAO - HNS）标准确诊为梅尼埃病且患有致残性眩晕的患者在接受内淋巴囊切开术后接受了庆大霉素治疗。治疗的目标是控制眩晕和保留听力。随访期为26至59个月。分别使用病史和纯音听力测定来评估眩晕控制情况和听力。在庆大霉素治疗前的6个月期间，眩晕发作频率为每月0.5至4次明确发作。庆大霉素治疗前的听力分级（AAO - HNS标准）在2至4级之间。通过曼 - 惠特尼U检验比较治疗前后0.5、1、2和3千赫兹处的纯音听力阈值。
实现了完全眩晕控制（A类；AAO - HNS）以及在0.5、1、2和3千赫兹处的听力保留。
