Hong Joon-Pyo, Byun Hayoung, Kim Min-Beom
Department of Otorhinolaryngology-Head and Neck Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Republic of Korea.
Air Defense Control & Command, 15th Fighter Wing, Gyeonggi-do 13102, Republic of Korea.
J Clin Med. 2025 Jun 18;14(12):4342. doi: 10.3390/jcm14124342.
To compare the outcomes of low-dose intratympanic gentamicin injection (ITGM) in managing intractable Meniere's disease (MD) between patients receiving a single injection versus multiple injections, and to explore the optimal number of ITGM repetitions. This retrospective study was conducted at a single tertiary medical center. Clinical charts of patients diagnosed with definite MD between 2015 and 2020 and given low-dose ITGM for intractable vertigo attacks were reviewed. A total of 33 patients were divided into two groups based on the number of ITGM procedures: the single injection group (SG, n = 14) and the multiple injection group (MG, n = 19). In the MG, additional ITGM was performed up to four times. Audiograms, caloric responses, and video head impulse tests (vHIT) were reviewed at each repetition of ITGM. After the first ITGM, both the SG and MG showed significant decreases in caloric responses and vHIT gains, without deterioration in hearing. In the MG group, a second ITGM was needed on average 8.1 ± 6.4 months after the initial ITGM due to persistent vertigo attacks. After the second ITGM, 8 out of 19 MG patients showed additional benefits in terms of reduced vertigo and further decreases in caloric responses. However, after the third and fourth ITGM, no further significant decline in vestibular function was observed, and there was no improvement in subjective dizziness. In the MG, gradual deterioration of hearing was observed. This finding suggests that performing additional low-dose ITGM in poorly responding or recurrent cases appears reasonable up to the second injection. For those who continue to experience vertigo episodes after two ITGM procedures, alternative therapeutic approaches should be considered to preserve hearing.
比较单次注射与多次注射低剂量鼓室内庆大霉素注射（ITGM）治疗难治性梅尼埃病（MD）的疗效，并探讨ITGM重复注射的最佳次数。本回顾性研究在一家三级医疗中心进行。回顾了2015年至2020年间被诊断为明确MD并接受低剂量ITGM治疗难治性眩晕发作的患者的临床病历。根据ITGM治疗次数，共33例患者分为两组：单次注射组（SG，n = 14）和多次注射组（MG，n = 19）。在MG组中，额外的ITGM最多进行4次。每次ITGM重复时均复查听力图、冷热试验反应和视频头脉冲试验（vHIT）。首次ITGM后，SG组和MG组的冷热试验反应和vHIT增益均显著降低，听力无恶化。在MG组中，由于持续性眩晕发作，平均在首次ITGM后8.1±6.4个月需要进行第二次ITGM。第二次ITGM后，19例MG患者中有8例在眩晕减轻和冷热试验反应进一步降低方面显示出额外益处。然而，第三次和第四次ITGM后，未观察到前庭功能进一步显著下降，主观头晕也无改善。在MG组中，观察到听力逐渐下降。这一发现表明，在反应不佳或复发的病例中，进行额外的低剂量ITGM直至第二次注射似乎是合理的。对于在两次ITGM治疗后仍持续出现眩晕发作的患者，应考虑采用其他治疗方法以保护听力。
