Department of Otology and Skull Base Surgery, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China.
Otol Neurotol. 2010 Jun;31(4):642-8. doi: 10.1097/MAO.0b013e3181dbb30e.
To compare the cochlear distribution of low-dose fluorescent gentamicin after intra-tympanic administration in guinea pig (GPs) with clinical data of low dose intra-tympanic gentamicin in patients with intractable vertigo.
Purified gentamicin-Texas Red (GTTR) was injected intratympanically into GPs and the cochlear distribution and time course of GTTR fluorescence in outer hair cells (OHCs) was determined using confocal microscopy.
GTTR was rapidly taken up by OHCs, particularly in the subcuticular zone. GTTR was distributed in the cochlea in a decreasing baso-apical gradient, and was retained within OHCs without significant decrease in fluorescence until 4 weeks after injection.
OHCs rapidly take up GTTR after intra-tympanic administration with slow clearance.
A modified low-dose titration intratympanic approach was applied to patients with intractable Ménière's Disease (MD) based on our animal data and the clinical outcome was followed. After the modified intratympanic injections for MD patients, vertigo control was achieved in 89% patients, with hearing deterioration identified in 16% patients. The 3-week interval titration injection technique thereby had a relatively high vertigo control rate with a low risk of hearing loss, and is a viable alternative to other intratympanic injection protocols.
比较豚鼠（GP）鼓室内给予低剂量荧光庆大霉素后的耳蜗分布与临床难治性眩晕患者低剂量鼓室内庆大霉素的数据。
纯化的庆大霉素-红色荧光素（GTTR）被鼓室内注射到 GP 中，并用共聚焦显微镜确定 GTTR 荧光在外毛细胞（OHC）中的耳蜗分布和时间过程。
GTTR 被 OHC 迅速摄取，特别是在表皮下区。GTTR 在耳蜗中呈逐渐降低的基底-顶梯度分布，并且在注射后 4 周内荧光无明显下降而保留在 OHC 内。
OHC 经鼓室内给药后迅速摄取 GTTR，清除缓慢。
根据我们的动物数据，对难治性梅尼埃病（MD）患者采用改良的低剂量滴定鼓室内给药方法，并随访其临床结果。对 MD 患者进行改良的鼓室内注射后，89%的患者眩晕得到控制，16%的患者出现听力下降。因此，3 周间隔滴定注射技术具有较高的眩晕控制率和较低的听力损失风险，是其他鼓室内注射方案的可行替代方案。
