Faizal Bini, Rajan Afsha
Department of ENT, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeedham, Kochi, India.
Indian J Otolaryngol Head Neck Surg. 2022 Aug;74(Suppl 1):320-325. doi: 10.1007/s12070-020-02104-4. Epub 2020 Sep 1.
Intratympanic gentamicin has become an accepted standard of care for Ménière's disease. But there still exists controversies regarding the dosing protocol as well as the drug concentration for optimum control of vertigo and hearing preservation. To determine if 20 mg of intratympanic gentamicin administered once a month for a maximum of 2 months can alleviate intractable vertigo caused by definite Ménière's disease with hearing preservation. Once diagnosed with definite Ménière's disease as per AAO-HNS criteria, the patient was given 0.5 ml of 40 mg/ml intratympanic gentamicin. Follow-up was done at 1-month and 6-month post-treatment. If at 1-month review patient continued to have vertigo one more dose of intratympanic gentamicin was administered. Thirty-two patients were included in the study. Seventeen patients (53.1%) received one dose and 15 patients (46.9%) received two doses of intratympanic injection. We achieved an effective vertigo control of 59.4% and complete vertigo control rate of 53.1%. Worsening of symptoms was noted in 1 patient. Hearing was preserved in all patients except for one. Among the patients who attained effective vertigo control, 72.2% had dead labyrinth at 6-month cold caloric status. A single injection of 20 mg intratympanic gentamicin can alleviate intractable vertigo caused by definite Ménière's disease with hearing preservation. Non-responders may be given a second dose after one month. Intratympanic gentamicin is a simple, cheap treatment that can be carried out in an out-patient setting.
鼓室内注射庆大霉素已成为梅尼埃病公认的治疗标准。但在给药方案以及药物浓度以实现眩晕的最佳控制和听力保留方面仍存在争议。为了确定每月一次鼓室内注射20mg庆大霉素，最多注射2个月，是否能缓解由明确的梅尼埃病引起的顽固性眩晕并保留听力。一旦根据美国耳鼻咽喉头颈外科学会（AAO-HNS）标准确诊为明确的梅尼埃病，患者接受0.5ml浓度为40mg/ml的鼓室内庆大霉素注射。在治疗后1个月和6个月进行随访。如果在1个月复查时患者仍有眩晕，则再给予一剂鼓室内庆大霉素。32例患者纳入本研究。17例患者（53.1%）接受了一剂注射，15例患者（46.9%）接受了两剂鼓室内注射。我们实现了59.4%的有效眩晕控制率和53.1%的完全眩晕控制率。1例患者症状加重。除1例患者外，所有患者听力均得以保留。在实现有效眩晕控制的患者中，72.2%在6个月冷热试验时出现内耳死亡。单次鼓室内注射20mg庆大霉素可缓解由明确的梅尼埃病引起的顽固性眩晕并保留听力。无反应者可在1个月后给予第二剂。鼓室内注射庆大霉素是一种简单、廉价的治疗方法，可在门诊进行。
