Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A; Faculty of Health Sciences, University of Brasilia, Brasilia, Distrito Federal, Brazil.
Laryngoscope. 2014 Sep;124(9):2151-4. doi: 10.1002/lary.24716. Epub 2014 Apr 29.
OBJECTIVES/HYPOTHESIS: Vertigo attacks in most cases of Meniere's disease (MD) are successfully treated with lifestyle changes and medication. However, approximately 6% of patients with MD develop drop attacks (DAs), a potentially life-threatening condition. Traditional treatment for DAs has been surgical labyrinthectomy. The objective of this study was to assess the effectiveness of intratympanic gentamicin for DAs in patients with MD.
Retrospective charts review.
All charts were reviewed from Meniere DA patients at our hospital during the 10-year period from 2002 to 2012 who had been treated with intratympanic gentamicin and had been followed for at least 1 year afterward.
Twenty-four ears fulfilled inclusion criteria. The time for manifestation of DAs varied from 1 to 20 years after diagnosis (mean 10 years). A total of 83.3% of ears with intractable MD and DA achieved complete symptom control of DAs after the first intratympanic gentamicin cycle and 95.8% after the further injections. Among patients with no DA recurrence by the end of the study follow-up, the symptom-free interval varied from 12 to 120 months (mean: 43.5 months). All 15 patients with ≥ 24 months follow-up were still free of DAs. Elevated or absent vestibular evoked myogenic potential thresholds were more common in DA than in contralateral ears, and hearing loss was not a major complication of the treatment.
Intratympanic gentamicin treatment appears to be a long-lasting and effective treatment for MD with DAs.
目的/假设：大多数梅尼埃病（MD）患者的眩晕发作通过生活方式改变和药物治疗都能成功治疗。然而，约有 6%的 MD 患者会出现跌倒发作（DA），这是一种潜在的危及生命的情况。DA 的传统治疗方法是手术迷路切除术。本研究的目的是评估鼓室内庆大霉素治疗 MD 患者 DA 的疗效。
回顾性图表审查。
回顾了 2002 年至 2012 年期间在我院接受鼓室内庆大霉素治疗且随访时间至少 1 年的 MD 伴 DA 患者的所有病历。
24 耳符合纳入标准。DA 的表现时间从诊断后 1 年到 20 年不等（平均 10 年）。83.3%的难治性 MD 伴 DA 耳在首次鼓室内庆大霉素循环后完全控制了 DA 的症状，95.8%在进一步注射后控制了 DA 的症状。在研究随访结束时无 DA 复发的患者中，无症状间隔从 12 到 120 个月不等（平均：43.5 个月）。所有 15 名随访时间≥24 个月的患者均无 DA 发作。DA 患者的前庭诱发肌源性电位阈值升高或缺失比对侧耳更常见，听力损失不是治疗的主要并发症。
鼓室内庆大霉素治疗似乎是 MD 伴 DA 的一种持久有效的治疗方法。
