Harner S G, Kasperbauer J L, Facer G W, Beatty C W
Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota 55905, USA.
Laryngoscope. 1998 Oct;108(10):1446-9. doi: 10.1097/00005537-199810000-00005.
Study the impact of transtympanic gentamicin on patients with unilateral Meniere's syndrome. Partial chemical labyrinthectomy is a relatively recent concept for the treatment of Meniere's syndrome. It uses the ototoxic effect of gentamicin to reduce the symptom of vertigo and maintain cochlear function.
A prospective study using transtympanic gentamicin was begun in January 1994. Patients selected had failed medical therapy, but were not incapacitated. Patients had preinjection audiometric and electronystagmography data. Most had an imaging study. All had one injection, about half had more than one. Patients were seen 1 month after therapy and repeat studies were obtained. Repeat injection was performed if indicated. Follow-up from the chart or by telephone was obtained. Data were tabulated using the 1995 American Academy of Otologaryngology-Head and Neck Surgery guidelines.
Through December 1996 43 patients with unilateral Meniere's syndrome were treated. The pretherapy function level was 3 through 5. After therapy the function level was 1 or 2. There was almost no change in cochlear function and no patient became deaf. Many patients had mild ataxia or dysequilibrium during the first 2 weeks following therapy. Most patients showed some decrease in labyrinthine function measured on electronystagmography. No attempt was made to ablate labyrinthine function. Seventeen of 18 patients had a vertigo index in the class A or B category after 2 years.
Transtympanic gentamicin has become the treatment of choice for patients who fail medical therapy for Meniere's syndrome at the authors' institution.
研究经鼓膜注射庆大霉素对单侧梅尼埃病患者的影响。部分化学性迷路切除术是治疗梅尼埃病的一个相对较新的概念。它利用庆大霉素的耳毒性作用来减轻眩晕症状并维持耳蜗功能。
1994年1月开始了一项使用经鼓膜注射庆大霉素的前瞻性研究。入选的患者药物治疗无效，但尚未失能。患者在注射前有听力测定和眼震电图数据。大多数患者进行了影像学检查。所有患者均接受一次注射，约一半患者接受了不止一次注射。治疗后1个月对患者进行检查并重复相关研究。如有必要则进行重复注射。通过查阅病历或电话进行随访。数据按照1995年美国耳鼻咽喉头颈外科学会的指南进行整理。
至1996年12月，43例单侧梅尼埃病患者接受了治疗。治疗前功能水平为3至5级。治疗后功能水平为1或2级。耳蜗功能几乎没有变化，没有患者失聪。许多患者在治疗后的前2周出现轻度共济失调或平衡失调。大多数患者眼震电图测量显示迷路功能有所下降。未试图消除迷路功能。18例患者中有17例在2年后眩晕指数为A或B级。
在作者所在机构，经鼓膜注射庆大霉素已成为梅尼埃病药物治疗无效患者的首选治疗方法。
