Junet Philippe, Karkas Alexandre, Dumas Georges, Quesada Jean Louis, Schmerber Sébastien
Department of Otolaryngology-Head and Neck Surgery, University of Grenoble, Grenoble, France.
Department of Otolaryngology-Head and Neck Surgery, University of Saint-Etienne, Saint-Etienne, France.
Eur Arch Otorhinolaryngol. 2016 Oct;273(10):3011-8. doi: 10.1007/s00405-015-3889-x. Epub 2016 Jan 16.
Intratympanic injection of gentamicin is increasingly used in the treatment of unilateral disabling Menière's disease (MD). Several objective functional and subjective tests have been developed to assess the control of vertigo after gentamicin treatment. The aim of this study was to show that subjective results require a vestibular deafferentation as profound as possible, evidenced with multifrequency vestibular assessment. Sixty four patients with intractable MD in situation of medical treatment failure longer than 6 months were included between 1998 and 2013 in this case control study. A 2-year follow-up was performed after the last intratympanic gentamicin performed with the titration technique. A vestibular assessment was applied before and after 2 years of treatment with a functional level score using the AAOHNS vertigo scale and multifrequency vestibular assessment: skull vibration-induced nystagmus test (SVINT), head-shaking test (HST) and caloric test (CaTe). The correlation between the results of the questionnaire and the level of the deafferentation as evaluated by the tests was analyzed with the Spearman test. Among the 64 included patients, 56 (87.5 %) described vertigo control. There was a correlation (=-0.33 [-0.53; -0.09], p = 0.008) between subjective improvement (AAO -HNS 1 or 2) and the degree of vestibular deafferentation as evidenced by a destructive nystagmus (beating toward the safe side) with the HST and the SVINT, as well as a caloric hypofunction >90 % with the CaTe. The present study demonstrates that a profound vestibular deafferentation confirmed with multifrequency test evaluation is needed to have a subjective improvement in the treatment of unilateral disabling MD with intratympanic gentamicin.
鼓室内注射庆大霉素越来越多地用于治疗单侧致残性梅尼埃病（MD）。已经开发了几种客观功能测试和主观测试来评估庆大霉素治疗后的眩晕控制情况。本研究的目的是表明主观结果需要尽可能深度的前庭传入神经阻滞，这可以通过多频前庭评估来证明。1998年至2013年期间，本病例对照研究纳入了64例药物治疗失败超过6个月的顽固性MD患者。在最后一次采用滴定技术进行鼓室内庆大霉素注射后进行了2年的随访。在治疗2年前后进行前庭评估，使用美国耳鼻咽喉头颈外科学会（AAOHNS）眩晕量表进行功能水平评分，并进行多频前庭评估：颅骨振动诱发眼震试验（SVINT）、摇头试验（HST）和冷热试验（CaTe）。使用Spearman检验分析问卷结果与测试评估的传入神经阻滞水平之间的相关性。在纳入的64例患者中，56例（87.5%）描述眩晕得到控制。主观改善（AAO -HNS 1级或2级）与前庭传入神经阻滞程度之间存在相关性（=-0.33 [-0.53；-0.09]，p = 0.008），这通过HST和SVINT中向安全侧跳动的破坏性眼震以及CaTe中>90% 的冷热功能减退来证明。本研究表明，在用鼓室内庆大霉素治疗单侧致残性MD时，需要通过多频测试评估确认深度前庭传入神经阻滞才能实现主观改善。
