Casani Augusto, Nuti Daniele, Franceschini Stefano Sellari, Gaudini Elisa, Dallan Iacopo
Department of Otorhinolaryngology, University of Pisa, Italy.
Otolaryngol Head Neck Surg. 2005 Dec;133(6):929-35. doi: 10.1016/j.otohns.2005.07.033.
To determine the effects of transtympanic injections, with a mixture composed of gentamicin and fibrin tissue adhesive (FTA), on vestibular function of patients with intractable unilateral Menière's disease.
This was an open, prospective study.
The study was performed at 2 tertiary referral centers. Twenty-six patients affected by "definite" unilateral Menière's disease, unresponsive to medical therapy for at least 6 months, were enrolled.
A buffered gentamicin solution mixed with FTA was injected in the middle ear until the development of bedside vestibular hypofunction signs and/or caloric weakness in the treated ear.
Vestibular function was evaluated by 3 bedside vestibular tests (observation of spontaneous nystagmus, head shaking test, and head thrust test) and by a caloric test. Tests were performed on days 10 and 30 after completion of treatment. Tests were also performed 3, 6, and 12 months from completion of the gentamicin-FTA protocol. The effects of treatment were also assessed in terms of hearing levels, control of vertigo, and disability status.
In 22 of the 26 patients, only 1 gentamicin-FTA injection was necessary to obtain 1 or more signs indicating a reduction of the vestibular function in the treated ear. Four patients needed another treatment because of the persistence of their incapacitating symptoms during the follow-up. Four patients needed more than 1 injection to obtain a vestibular hypofunction. None of the patients who received 1 or 2 injections presented hearing loss in direct temporal relationship to the treatment.
A mixture of gentamicin and fibrin glue makes it possible to considerably reduce the number of administrations in patients with intractable unilateral Menière's disease. Spontaneous nystagmus, post head shaking nystagmus, and a head thrust sign are the clinical signs that indicate onset or progression of unilateral vestibular hypofunction. These signs were obtained with only 1 injection in 81% of patients.
确定庆大霉素与纤维蛋白组织黏合剂（FTA）混合经鼓膜注射对单侧梅尼埃病患者前庭功能的影响。
这是一项开放性前瞻性研究。
研究在2个三级转诊中心进行。纳入了26例患有“明确”单侧梅尼埃病且至少6个月药物治疗无效的患者。
将缓冲后的庆大霉素溶液与FTA混合后注入中耳，直至治疗耳出现床边前庭功能减退体征和/或冷热试验减弱。
通过3项床边前庭试验（观察自发性眼震、摇头试验和头脉冲试验）和冷热试验评估前庭功能。在治疗完成后的第10天和第30天进行测试。在完成庆大霉素 - FTA方案后的3、6和12个月也进行测试。还根据听力水平、眩晕控制和残疾状况评估治疗效果。
26例患者中有22例仅需1次庆大霉素 - FTA注射即可获得1项或多项表明治疗耳前庭功能降低的体征。4例患者因随访期间致残症状持续存在而需要再次治疗。4例患者需要多次注射才能获得前庭功能减退。接受1次或2次注射的患者均未出现与治疗直接相关的听力损失。
庆大霉素与纤维蛋白胶的混合物能够显著减少单侧梅尼埃病患者的给药次数。自发性眼震、摇头后眼震和头脉冲征是表明单侧前庭功能减退开始或进展的临床体征。81%的患者仅1次注射即可出现这些体征。
