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Meniere's
Research: 2002-2006
Drug Saf. 2006;29(11):1049-59.
Betahistine: a retrospective synopsis of safety data.
Jeck-Thole S, Wagner W.
Solvay Pharmaceuticals, Hannover, Germany.
Betahistine is a structural analogue of histamine that is prescribed for the
treatment of vestibular disorders such as Meniere's disease and the symptomatic
treatment of vertigo. It is estimated from sales information that >130 million
patients have been exposed to the drug since its registration in 1968. In this
review we analyse the safety profile of betahistine based on data obtained
during >35 years of worldwide postmarketing surveillance.Until 31 December 2005,
554 adverse drug reaction (ADR) reports with 994 individual signs and symptoms
were received by the marketing authorisation holder from worldwide sources and
were reviewed and evaluated. Signs and symptoms of cutaneous hypersensitivity
reactions during betahistine therapy were the most frequently reported
complaints. They consisted of usually mild and self-limiting rash, pruritus and
urticaria, and all symptoms were reversible after drug discontinuation.
Betahistine was reported to be involved in one anaphylactoid reaction and one
case of Stevens-Johnson syndrome. Anaphylactic reactions with fatal outcome were
not reported.The reports that describe gastrointestinal complaints mostly
concern nausea and vomiting or unspecific abdominal pain. These were typically
non-serious complaints. Hepatobiliary involvement was reported 25 times,
including increases in alkaline phosphatase, gamma-glutamyltransferase, and
alanine and aspartate aminotransferase levels. None of the patients concerned
developed severe liver failure or died. ADRs related to the nervous system
predominantly reveal heterogeneous events that are not suggestive of a specific
adverse reaction profile for betahistine. A clinical intolerance to betahistine
that gave rise to asthma or bronchospasm was only reported in eight ADRs. A
total of three cases of neoplasm have been reported. One case concerned a male
patient of unknown age who experienced weight loss, insomnia, impatience and
irritability soon after the start of betahistine therapy. An undiagnosed
phaeochromocytoma was suspected. The remaining two cases were assessed as being
unrelated to betahistine by the reporter. Finally, four deaths have been
reported during the course of postmarketing surveillance for betahistine. The
reporter assessed the causal relationship to betahistine in two as unrelated, in
one as unlikely and the other as unassessable.In summary, clinical and
postmarketing studies have revealed a good safety profile of betahistine that
was confirmed by the safety surveillance data presented.
-----
Psychosom Med. 2006 Sep-Oct;68(5):762-9.
Evaluation of booklet-based self-management of symptoms in
Meniere disease: a randomized controlled trial.
Yardley L, Kirby S.
School of Psychology, University of Southampton, Highfield, Southampton SO17
1BJ, UK. L.Yardley@soton.ac.uk
OBJECTIVE: This study examined the effectiveness of booklet-based education in
vestibular rehabilitation (VR) and symptom control (SC) techniques to manage
vertigo and dizziness in Meniere disease. METHODS: Participants (n = 360) were
randomized to a waiting list control group or to receive either a VR or an SC
self-management booklet. VR involved provoking dizziness in a controlled manner
by making repeated head movements in order to promote neurological and
psychological habituation. SC involved using applied relaxation, challenging
negative beliefs, and lifestyle modification to reduce amplification of
dizziness by anxiety. Subjective improvement in health, enablement (ability to
understand and cope with symptoms), and adherence were measured at 3 and 6
months. Symptoms, handicap, anxiety and depression, and negative beliefs about
symptoms were assessed pretreatment and at 3 and 6 months. RESULTS: At 6-month
follow-up, 45 (37.5%) of the VR group and 47 (39.2%) of the SC group reported
improvement compared with 19 (15.8%) controls; the relative probability of
improvement compared with controls was 2.37 (95% confidence interval [CI],
1.48-3.80) for VR and 2.47 (95% CI, 1.55-3.95) for SC. Both intervention groups
reported greater enablement than controls (p < .001, d > 0.70). At 3 months, the
VR group had reduced symptoms, anxiety, handicap, and negative beliefs about
dizziness; the SC group had reduced handicap; but the control group showed no
improvement. Reported adherence levels were low and strongly related to outcome.
CONCLUSIONS: Self-management booklets offer an inexpensive and easily
disseminated means of helping people with Meniere disease to cope with dizziness
symptoms.
-----
Otol Neurotol. 2006 Sep 15; [Epub ahead of print]
Quality-of-Life Assessment of Meniere's Disease Patients After
Surgical Labyrinthectomy.
Diaz RC, Larouere MJ, Bojrab DI, Zappia JJ, Sargent EW, Shaia WT.
*Michigan Ear Institute, Farmington Hills, Michigan, U.S.A.; daggerOtology,
Neurotology, and Skull Base Surgery Service, Providence Hospital, Southfield,
Michigan, U.S.A.; and double daggerDepartment of Otolaryngology-Head and Neck
Surgery, Wayne State University, Detroit, Michigan, U.S.A.
OBJECTIVE:: To examine the impact of surgical labyrinthectomy on quality of life
of Meniere's disease patients. STUDY DESIGN:: Cross-sectional survey. SETTING::
Otology subspecialty referral center. PATIENTS:: All patients with Meniere's
disease who underwent surgical labyrinthectomy between 1998 and 2004 were
selected. Fifty-three patients satisfied inclusion criteria. Completed
questionnaires were obtained from 44 patients. INTERVENTION(S):: The Meniere's
Disease Outcomes Questionnaire is a disease-specific quality-of-life
questionnaire. It was used to assess the quality of life of patients before and
after surgical labyrinthectomy. The questionnaire encompasses physical, mental,
and social well-being domains of quality of life. MAIN OUTCOME MEASURE(S)::
Change in total quality-of-life score was used to assess the overall impact of
surgical labyrinthectomy on subjective patient outcome. Individual
quality-of-life domains were also assessed. RESULTS:: Forty-three of 44
respondents (98%) had improvement in total score after surgery. The one patient
who demonstrated deterioration developed latent contralateral disease. Average
preoperative and postoperative scores were 34 +/- 14 and 67 +/- 15, respectively
(p < 0.001). All questions showed significant improvement with surgery (p <
0.001) except questions pertaining to memory (no change) and hearing loss (nonsignificant
decrease in score). CONCLUSION:: This study comprises the first patient-directed
assessment of quality-of-life outcomes in Meniere's disease patients after
labyrinthectomy. Despite the disadvantage of hearing loss, patients consistently
reported significant improvement in all quality-of-life domains and do not
report a significant loss of quality of life in terms of their hearing loss.
Surgical labyrinthectomy remains a highly effective treatment for Meniere's
disease patients.
-----
J Laryngol Otol. 2006 Sep;120(9):730-5. Epub 2006 Jul 19.
Intratympanic gentamicin treatment in Meniere's disease:
patients' experiences and outcomes.
Smith WK, Sandooram D, Prinsley PR.
Department of ENT Surgery, Addenbrookes Hospital, Cambridge, UK.
OBJECTIVE: The aim of this study was to assess the experiences and outcomes of
patients receiving intratympanic gentamicin treatment for Meniere's disease in
Norfolk, UK. DESIGN: This study was based on a retrospective questionnaire
survey and a review of patients' medical records. SETTING: Two district
hospitals. PARTICIPANTS: All 29 patients treated between 1999 and 2001, with a
minimum follow up of two years post-treatment, were included in the study.
Twenty-three patients completed the questionnaires (79 per cent response rate).
MAIN OUTCOME MEASURES: Glasgow benefit inventory (GBI) and vertigo symptom scale
(VSS) scores, plus change in hearing thresholds. RESULTS: The mean GBI total
score was +36, indicating substantial improvement in patients' overall quality
of life following gentamicin treatment. The VSS scores demonstrated low levels
of vertigo or unsteadiness in treated patients. Three patients suffered
deterioration in their hearing thresholds following a single injection of
gentamicin. However, 96 per cent of responders stated that they would be willing
to have such treatment again, if necessary. CONCLUSION: Intratympanic gentamicin
treatment ought to be offered to Meniere's patients suffering from disabling
vertigo, with the proviso that they be made aware of the possibility of hearing
deterioration.
-----
Consult Pharm. 2006 Sep;21(9):680-96.
Vertigo: few new spins on a common problem.
Zanni GR, Wick JY.
National Cancer Institute, National Institutes of Health, Bethesda, Maryland,
USA.
Vertigo is a common balance deregulation symptom among elders. Its etiology may
be peripheral vestibular disease or a central vestibular disorder. Symptom
onset, severity, and duration are distinguishing characteristics. The majority
of peripheral vestibular disorders include benign paroxysmal positional vertigo,
vestibular neuronitis, Meniere's disease, and perilymph fistula. Medication
regimen review is necessary to identify possible drug-induced etiology.
Treatment options include pharmacotherapy, canalith repositioning procedures,
surgery, vestibular rehabilitation therapy, and dietary interventions.
-----
Otol Neurotol. 2006 Sep;27(6):896-900.
Factors Relating to the Vertigo Control and Hearing Changes
Following Intratympanic Gentamicin for Intractable Meniere's Disease.
Horii A, Saika T, Uno A, Nishiike S, Mitani K, Nishimura M, Kitahara T,
Fukushima M, Nakagawa A, Masumura C, Sasaki T, Kizawa K, Kubo T.
Department of Otolaryngology, Osaka University Medical School, Japan.
OBJECTIVE:: To look for factors relating to the vertigo control and hearing
changes after intratympanic injections of gentamicin (GM). STUDY DESIGN::
Prospective. SETTING:: Tertiary referral medical center. PATIENTS:: Twenty-eight
patients with intractable Meniere's disease. INTERVENTIONS:: Three intratympanic
injections of GM (once per day for three consecutive days). MAIN OUTCOME
MEASURES:: Although five patients needed further GM injections or vestibular
neurectomy because of poor control (Group I), 23 patients had their vertigo
controlled for more than two years without further treatment (Group II). The
number of vertigo spells per month, pure-tone audiometry, electrocochleography,
caloric response, post-head shake nystagmus, and plasma vasopressin as a stress
marker were examined. RESULTS:: Before GM injections, there was no difference in
the number of vertigo spells per month between Groups I and II. However, the
hearing thresholds were higher in Group I. Hearing improvement, increase in
percentage of canal paresis and induction of post-head shake nystagmus were
observed after GM injections only in Group II. Even in the 11 patients who
showed an improvement in hearing of more than 10 dB (hearing improvement group),
percentage of canal paresis was increased after GM. More, premedication plasma
vasopressin levels were lower in the hearing improvement group as compared with
the hearing loss/no changes group. Four of eight patients became negative for
dominant negative summating potential in electrocochleography after GM
injections in the hearing improvement group. CONCLUSION:: Our data indicate that
the frequency of vertigo is not a key factor in the vertigo control after GM
injections, that induction of vestibular damage in the injected ear is essential
for the control of vertigo and this effect is mostly pronounced in patients with
milder hearing loss, and that hearing improvement is not only a consequence of
good vertigo control but also affected by the stress level before treatment.
-----
Eur Arch Otorhinolaryngol. 2006 Sep;263(9):791-7. Epub 2006 May 25.
Intratympanic steroid therapy for inner ear diseases, a review of
the literature.
Alles MJ, der Gaag MA, Stokroos RJ.
Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital
Maastricht, P. Debyelaan 25, P.O. Box 5800, 6202 AZ, Maastricht, The
Netherlands, RSTO@SKNO.AZM.NL.
To evaluate the value of clinical trials on intratympanic steroid therapy in
Meniere's disease (MD), idiopathic sudden sensorineural hearing loss (ISSNHL)
and rapidly progressive sensorineural hearing loss (RPSNHL). Medline and Pubmed
databases from 1966 to present were searched for clinical studies on intra- or
transtympanic (cortico)steroid therapy of MD, ISSNHL and RPSNHL. Results were
cross-checked with additional databases to obtain a complete data set. Clinical
trials were evaluated on the basis of comparability, internal and external
validity. Articles were judged using the following questions: was a randomised
double-blind controlled trial performed? Which criteria were used to confirm the
diagnosis of MD, ISSNHL, RPSNHL? Which therapy was evaluated? How long was the
follow-up? Which criteria were used to evaluate the results? Reliable evidence
on the efficiency, optimum dosage and administration schedule of intratympanic
steroid therapy in MD, ISSNHL and RPSNHL is lacking, therefore further
investigation is required.
-----
Otol Neurotol. 2006 Aug;27(5):687-96.
Outcome-based assessment of endolymphatic sac decompression for
Meniere's disease using the Meniere's disease outcome questionnaire: a review of
90 patients.
Convert C, Franco-Vidal V, Bebear JP, Darrouzet V.
Skull Base Surgery Department, University of Bordeaux, Bordeaux, France.
OBJECTIVE: To evaluate the quality of life (QOL) of patients treated by
endolymphatic sac decompression (ELSD) for Meniere's disease (MD) with a
dedicated questionnaire, while recording the results of this surgery on vertigo
attacks using the American Academy of Otolaryngology-Head and Neck Surgery
criteria. STUDY DESIGN: Retrospective case review in a tertiary referral care
center. MATERIAL AND METHODS: Ninety patients who have MD were treated by ELSD
at our institution between 1986 and 2004. They were sent a 40-question Meniere's
Disease QOL dedicated questionnaire (Meniere's Disease Outcome Questionnaire)
concerning physical, mental, and social well-being. Five scores out of 100 were
calculated (S1-S5): S3 for preoperative QOL score, S4 for postoperative QOL
score, S5 for change in QOL score (S5 = S4 - S3), and S1 and S2 representing the
answers to two other paired questions about the "overall" feeling of the
patients. In parallel, results of ELSD on vertigo attacks and hearing were
evaluated using the Academy of Otolaryngology-Head and Neck Surgery criteria.
RESULTS: Fifty-nine interpretable answers (65.6%) to the Meniere's Disease
Outcome Questionnaire were obtained from 28 men and 31 women (mean age, 56 yr
and 9 mo), all suffering from "definite" MD. The mean S3 was 32.5 (range,
9.7-84.7), and the mean S4 was 60.8 (range, 0-98.6). Consecutively, S5 score was
28.3 (range, -34.7 to 77.4). QOL improved in 81.4% of cases with an average
duration of follow-up of 57.5 months (range, 4-156 mo) (p < 0.001), worsened in
11.9% and was stable in 6.8%. There was no statistically significant difference
as a function of sex (p = 0.7) or length of follow-up (p = 0.6). There was a
significant correlation between S1 and S3 (p < 0.0001), and S2 and S4 (p <
0.0001), validating the whole questionnaire. In addition, 71% of satisfactory
control of vertigo at 2 years postoperatively was noted. Hearing was improved or
unchanged in 79% of cases at 3 months postoperatively. CONCLUSION: These results
show that ELSD significantly improves the health of patients. It represents a
first-line procedure that preserves the vestibular and afferent structures,
unlike vestibular neurotomy and chemical labyrinthectomy, which may be indicated
as a second line.
-----
Cochrane Database Syst Rev. 2006 Jul 19;3:CD003599.
Diuretics for Meniere's disease or syndrome.
Thirlwall AS, Kundu S.
Royal Berkshire Hospital, Ear, Nose & Throat Department, London Road, Reading,
UK RG1 5AN. andy_thirlwall@hotmail.com
BACKGROUND: Meniere's disease is a disorder characterised by hearing loss,
tinnitus and disabling vertigo. Diuretics are used to try and reduce the
severity and frequency of episodes but there is little evidence behind this
treatment. OBJECTIVES: To assess the effect of diuretic treatment in patients
with Meniere's disease. SEARCH STRATEGY: We searched the Cochrane Ear, Nose and
Throat Disorders Group Trials Register, the Cochrane Central Register of
Controlled Trials (CENTRAL) (The Cochrane Library, Issue 1 2005), MEDLINE (1966
to 2005), EMBASE (1974 to 2005), CINAHL and the metaRegister of Controlled
Trials (mRCT) (up to 2005). SELECTION CRITERIA: Randomised controlled trials of
diuretic versus placebo in Meniere's patients. DATA COLLECTION AND ANALYSIS: One
author identified studies which loosely met the inclusion criteria and full
texts were retrieved. Two authors independently applied the inclusion criteria.
Seven studies were excluded from the review due to inappropriate study design or
absence of randomisation. MAIN RESULTS: There were no trials of high enough
quality to meet the standard set for this review. AUTHORS' CONCLUSIONS: There is
insufficient good evidence of the effect of diuretics on vertigo, hearing loss,
tinnitus or aural fullness in clearly defined Meniere's disease.
-----
J Laryngol Otol. 2006 Jul 19;:1-6 [Epub ahead of print]
Intratympanic gentamicin treatment in Meniere's disease:
Patients' experiences and outcomes.
Smith WK, Sandooram D, Prinsley PR.
Department of ENT Surgery, Addenbrookes Hospital, Cambridge.
Objective: The aim of this study was to assess the experiences and outcomes of
patients receiving intratympanic gentamicin treatment for Meniere's disease in
Norfolk, UK.Design: This study was based on a retrospective questionnaire survey
and a review of patients' medical records.Setting: Two district
hospitals.Participants: All 29 patients treated between 1999 and 2001, with a
minimum follow up of two years post-treatment, were included in the study.
Twenty-three patients completed the questionnaires (79 per cent response
rate).Main outcome measures: Glasgow benefit inventory (GBI) and vertigo symptom
scale (VSS) scores, plus change in hearing thresholds.Results: The mean GBI
total score was +36, indicating substantial improvement in patients' overall
quality of life following gentamicin treatment. The VSS scores demonstrated low
levels of vertigo or unsteadiness in treated patients. Three patients suffered
deterioration in their hearing thresholds following a single injection of
gentamicin. However, 96 per cent of responders stated that they would be willing
to have such treatment again, if necessary.Conclusion: Intratympanic gentamicin
treatment ought to be offered to Meniere's patients suffering from disabling
vertigo, with the proviso that they be made aware of the possibility of hearing
deterioration.
-----
J Laryngol Otol. 2006 May 17;:1-5 [Epub ahead of print]
Intratympanic Gentamicin for Meniere's disease: effect on quality
of life as assessed by Glasgow benefit inventory.
Banerjee AS, Johnson IJ.
Newcastle Balance Centre, Department of Otology, Freeman Hospital, Newcastle
upon Tyne, UK.
Objectives: To evaluate patients' quality of life after receiving intratympanic
gentamicin as treatment for Meniere's disease.Design: Retrospective study using
the Glasgow benefit inventory scale (GBI) questionnaire.Participants: Patients
diagnosed with Meniere's disease, according to the American Academy of
Otolaryngology-Head and Neck Surgery (AAO-HNS) diagnostic criteria (refractory
to medical management), who were treated with intratympanic gentamicin
injection.Materials and methods: This retrospective study included all patients
diagnosed with Meniere's disease (according to AAO-HNS criteria; refractory to
medical management) undergoing gentamicin labyrinthectomy in our unit over the
preceding three years. Other causes of hearing loss were ruled out as all
patients underwent magnetic resonance imaging, electronystagmography and sway
magnetometry. Patients underwent gentamicin infiltration at a concentration of 2
ml of 30 mg/ml and were reviewed six weeks later and received a repeat injection
if no benefit was evident. Six months after their last follow up, they were sent
a GBI questionnaire. Twenty-one questionnaires were posted, and the response
rate was 81 per cent.Results: As per the responses received, the total benefit
of intratympanic gentamicin injection was found to be +30.3. The three
components of GBI were analysed separately; it was found that general benefit
was greatest (+33.3), followed by physical benefit (+28.1) and social benefit
(+21.6).Conclusion: This study suggests that gentamicin definitely improves
quality of life in patients with Meniere's disease and should be the first line
of treatment if medical management fails.
-----
Acta Otolaryngol. 2006 Mar;126(3):254-8.
Functional outcome of treatment of Meniere's disease with the
Meniett pressure generator.
Stokroos R, Olvink MK, Hendrice N, Kingma H.
Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital
Maastricht, Maastricht, The Netherlands. rsto@skno.azm.nl
CONCLUSION: Use of the Meniett pressure generator in patients with active
Meniere's disease (MD) did not affect labyrinthine function. OBJECTIVE: To
investigate whether application of the Meniett pressure generator in patients
with active MD significantly affects their labyrinthine function. MATERIAL AND
METHODS: We measured hearing and labyrinth sensitivity in patients with
established MD according to American Academy of Otolaryngology-Head and Neck
Surgery (AAO-HNS) criteria at five different time periods: at baseline; before
ventilation tube placement; before Meniett treatment; immediately after Meniett
treatment; and 1 month after cessation of Meniett treatment. RESULTS: A total of
32 patients met the inclusion criteria and were included in the study. They were
graded as having definite MD (AAO-HNS stages 2 and 3). No statistically
significant changes in labyrinthine function were found during Meniett
treatment.
-----
J Laryngol Otol. 2006 Feb;120(2):98-102. Epub 2005 Nov 25.
Outcomes in the use of intra-tympanic gentamicin in the treatment
of Meniere's disease.
Flanagan S, Mukherjee P, Tonkin J.
Department of Otolaryngology, St Vincent's Hospital, Sydney, New South Wales,
Australia.
The pathogenesis of Meniere's disease is associated with a disorder of ionic
homeostasis, with the pathologic correlate being endolymphatic hydrops. Despite
uncertainty as to its particular mode of action, it is accepted wisdom that
intra-tympanic gentamicin has a definite therapeutic role in the control of
symptoms in patients who fail to respond to medical therapy. This study reports
an evaluation of the efficacy of intra-tympanic gentamicin in the treatment of
Meniere's disease and also presents a simple, reliable, safe method of
administering gentamicin for this purpose. A retrospective review of 56 patients
undergoing intra-tympanic gentamicin treatment for Meniere's disease was
conducted. Response to treatment was analysed using a patient survey and
examination of pure-tone averages. An overall significant improvement in vertigo
symptoms of 81.3 per cent was found. There was a 21.4 per cent rate of
significant hearing loss, defined as greater than 10 dB, with an average loss in
this group of 18.5 dB. A single dose of gentamicin applied directly to the round
window resulted in a high rate of control of vertigo, with acceptably low rates
of hearing loss.
-----
Curr Opin Neurol. 2006 Feb;19(1):33-40.
Pharmacological advances in the treatment of neuro-otological and
eye movement disorders.
Strupp M, Brandt T.
Department of Neurology, University of Munich, Germany. Michael.Strupp@med.uni-muenchen.de
PURPOSE OF REVIEW: First, to describe the current pharmacological treatment
options for peripheral and central vestibular, cerebellar, and ocular motor
disorders. Second, to identify vestibular and ocular motor disorders in which
treatment trials are warranted. RECENT FINDINGS: Peripheral vestibular
disorders: In vestibular neuritis recovery of the peripheral vestibular function
can be improved by treatment with oral corticosteroids. In Meniere's disease
treatment strategies range from low-salt diet, diuretics, and betahistine, to
intratympanic injection of corticosteroids or gentamicin. Unfortunately most of
the trials on Meniere's disease do not have an up-to-date design. In bilateral
vestibulopathy steroids do not seem to improve vestibular function.Central
vestibular, cerebellar, and ocular motor disorders: The use of aminopyridines
introduced a new therapeutic principle in the treatment of downbeat and upbeat
nystagmus and episodic ataxia type 2 (EA2). These potassium channel blockers
presumably increase the activity and excitability of cerebellar Purkinje cells,
thereby augmenting the inhibitory influence of these cells on vestibular and
cerebellar nuclei. A few studies showed that baclofen improves periodic
alternating nystagmus, and gabapentin and memantine, pendular nystagmus. Many
other eye movement disorders, however, such as ocular flutter, opsoclonus,
central positioning, or see-saw nystagmus are still difficult to treat. SUMMARY:
Although progress has been made in the treatment of vestibular neuritis,
downbeat and upbeat nystagmus, as well as EA2, state-of-the-art trials must
still be performed on many vestibular and ocular motor disorders, namely
Meniere's disease, bilateral vestibulopathy, vestibular paroxysmia, vestibular
migraine, and many forms of central eye movement disorders.
-----
Ugeskr Laeger. 2006 Jan 23;168(4):378-80.
[Local overpressure treatment reduces vestibular symptoms in
patients with Meniere's disease--secondary publication. A clinically randomised
multicenter double-blind placebo-controlled study]
[Article in Danish]
Thomsen JC, Sass K, Odkvist L, Arlinger S.
Amtssygehuset i Gentofte, Ore-, naese- og halsafdeling E, Hellerup, Denmark.
jetho@gentoftehosp.kbhamt.dk
This investigation was performed to evaluate the efficacy of a new device, the
Meniett, in the treatment of Meniere's disease. The device delivers pressure
pulses to the middle ear through a ventilating tube in the tympanic membrane.
These pressure changes are conveyed to the inner ear, reducing the endolymphatic
hydrops. The device is significantly effective in reducing the vestibular
symptoms, as compared with the placebo device. Local overpressure treatment is a
novel treatment that is non-invasive, non-destructive and safe. It should be
offered to patients before more invasive surgical modalities are suggested.
-----
Ann Otolaryngol Chir Cervicofac. 2005 Dec;122(6):271-80.
[Vestibular neurotomy versus chemical labyrinthectomy for
disabling Meniere disease]
[Article in French]
Morel N, Dumas G, Nguyen DQ, Mohr E, Hitter A, Schmerber S.
Service d'oto-rhino-laryngologie, CHRU Grenoble, 38043 Cedex 09.
OBJECTIVE: To evaluate the efficiency on the vertigos and the impact on the
audition of the vestibular neurotomy (VN) and the chemical labyrinthectomy (CL)
in patients with severe Meniere's disease, in order to determine the precise
place for each technique in treatment algorithm. METHOD: Retrospective study of
71 VN (performed between 1986 and 2003) and 35 CL (performed between 1997 and
2003). These two treatments both aim at obtaining a vestibular deafferentation
in order to free definitely the patient of vertigo manifestations. Vestibular
results have been assessed by caloric tests performed before and 6 months after
treatment. Subjective success was evaluated by searching for recurrent attacks
of vertigo and by the AAO-HNS (American Academy of Otolaryngology-Head and Neck
Society) scale of subjective evaluation of vertigos (follow-up of 6.4 years
after VN and 2.4 years after CL). Pure tone audiometry before treatment and then
6 months later was performed. Complications of two types of treatment were
recorded and evaluated. RESULTS: In 90% of the cases after VN and 86% of the
cases after CL, caloric tests indicated a strong vestibular hyporeflexy (hypovalence
> 90%). Attacks of vertigo reoccurred in 5.6% of the cases when the hyporeflexy
was strong and 85.7% of the cases when it was weak. The quality of the
vestibular results on vertigo depends on the degree of hypovalence after
treatment. An improvement of the AAO-HNS scale have been obtained in 93% of the
cases in the NV group and in 81% of the cases in the LC group. Attacks of
vertigo were recurrent in 7% of the patients operated on by VN and 11.4% of the
patients treated by CL. Mean pure tone auditory thresholds changed from 50.24 dB
HL to 55.64 dB HL (p=0.003) in the VN group and from 69.11 dB HL to 74.51 dB HL
(p=0.41) in the CL group. Comparison of the variations of the mean pure tone
auditory thresholds before treatment and 6 months after the end of the treatment
doesn't show any significant difference between the 2 groups (p > 0.05).
Impairment of the audition superior to 20 dB HL was observed in 8.5% of the
patients of each group. The auditive results are similar in the 2 groups.
CONCLUSION: These two methods of treatment can not be strictly compared due to
several bias in this study. Indeed more patients were treated by VN with a
longer follow-up and only the patients with a class C or D audition according to
the criteria of the AAO-HNS could be treated by CL. The VN provides a better
control of the vertigos than the CL which is an efficient method of treatment in
invalidating Meniere's disease. In all the cases, the quality of the results on
vertigos depends on the degree of hypovalence after treatment. The auditive
results are similar. Since the results of the two treatments are similar, the
simplicity of CL encourages us to broaden the indications and to modify the
place of the VN in the therapeutic algorithm of Meniere's disease.
-----
Int Tinnitus J. 2005;11(1):38-42.
Sodium enoxaparin treatment of sensorineural hearing loss: an
immune-mediated response?
Mora R, Jankowska B, Passali GC, Mora F, Passali FM, Crippa B, Quaranta N,
Barbieri M.
ENT Department, University of Genoa, Italy. renzomora@libero.it
The authors propose the existence of a new entity of autoimmune sensorineural
hearing loss on the basis of diagnostic study and treatment experience with a
series of 30 patients. Immunological mechanisms play an important role in the
pathogenesis and natural course of various inner-ear diseases. Patients may
present clinically with symptoms resembling Meniere's disease or even with
sudden deafness. Currently, no widely used standard protocol for treatment of
this autoimmune sensorineural hearing loss exists. Prompted by such
observations, we implemented a protocol using a particular kind of
heparin--sodium enoxaparin--with a low molecular weight. Patients were randomly
assigned to two groups; to those in the first group, enoxaparin was administered
subcutaneously at a dose of 2,000 IU twice daily for 10 days; the patients in
the second group were treated with placebo. At the beginning and at the end of
the therapy period, the patients were evaluated by instrumental examinations.
Specifically excluded were patients with abnormal known coagulation. On
discharge, all patients treated with enoxaparin presented both a subjective and
objective decrease in symptoms. No patient experienced side effects from this
treatment. The results indicate that administration of sodium enoxaparin abates
sensorineural hearing loss in patients with autoimmune diseases. The clinical
response to therapy can confirm diagnosis.
-----
Otolaryngol Head Neck Surg. 2005 Dec;133(6):929-35.
Transtympanic gentamicin and fibrin tissue adhesive for treatment
of unilateral Meniere's disease: effects on vestibular function.
Casani A, Nuti D, Franceschini SS, Gaudini E, Dallan I.
Department of Otorhinolaryngology, University of Pisa, Italy. a.casani@med.unipi.it
OBJECTIVE: To determine the effects of transtympanic injections, with a mixture
composed of gentamicin and fibrin tissue adhesive (FTA), on vestibular function
of patients with intractable unilateral Meniere's disease. STUDY DESIGN: This
was an open, prospective study. SETTING AND PATIENTS: The study was performed at
2 tertiary referral centers. Twenty-six patients affected by "definite"
unilateral Meniere's disease, unresponsive to medical therapy for at least 6
months, were enrolled. INTERVENTION: A buffered gentamicin solution mixed with
FTA was injected in the middle ear until the development of bedside vestibular
hypofunction signs and/or caloric weakness in the treated ear. MAIN OUTCOME
MEASURE: Vestibular function was evaluated by 3 bedside vestibular tests
(observation of spontaneous nystagmus, head shaking test, and head thrust test)
and by a caloric test. Tests were performed on days 10 and 30 after completion
of treatment. Tests were also performed 3, 6, and 12 months from completion of
the gentamicin-FTA protocol. The effects of treatment were also assessed in
terms of hearing levels, control of vertigo, and disability status. RESULTS: In
22 of the 26 patients, only 1 gentamicin-FTA injection was necessary to obtain 1
or more signs indicating a reduction of the vestibular function in the treated
ear. Four patients needed another treatment because of the persistence of their
incapacitating symptoms during the follow-up. Four patients needed more than 1
injection to obtain a vestibular hypofunction. None of the patients who received
1 or 2 injections presented hearing loss in direct temporal relationship to the
treatment. CONCLUSIONS: A mixture of gentamicin and fibrin glue makes it
possible to considerably reduce the number of administrations in patients with
intractable unilateral Meniere's disease. Spontaneous nystagmus, post head
shaking nystagmus, and a head thrust sign are the clinical signs that indicate
onset or progression of unilateral vestibular hypofunction. These signs were
obtained with only 1 injection in 81% of patients.
-----
Acta Otolaryngol. 2005 Dec;125(12):1283-9.
Meniett therapy: rescue treatment in severe drug-resistant
Meniere's disease?
Boudewyns AN, Wuyts FL, Hoppenbrouwers M, Ketelslagers K, Vanspauwen R, Forton
G, Van De Heyning PH.
Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University
Hospital, University of Antwerp, Antwerp, Belgium.
Conclusion. Our data indicate that Meniett therapy is unlikely to be helpful in
the long-term treatment of patients with severe, drug-resistant Meniere's
disease (MD) in whom injection of intratympanic gentamicin (ITG) or another
destructive procedure would otherwise be performed. Objective. To investigate
the value of Meniett therapy in patients with drug-resistant MD referred for
injection of ITG. Material and methods. Twelve patients referred for ITG
treatment were followed during a 2-month period of Meniett therapy. Symptoms,
functional level and hearing status were evaluated using a standardized staging
system. Disease-specific quality-of-life measures were obtained before and after
Meniett therapy. At the end of the study period, patients were followed for a
mean of 37 months, thus providing long-term outcome data. Results. In two
patients, Meniett treatment was interrupted after 1 month because of persistent
severe vertigo. In the remaining 10 subjects, we found a significant decrease in
the median number of vertigo spells from 10.0/month (25th-75th percentile
4.0-19.0) prior to treatment to 3.0/month (25th-75th percentile 1.5-4.5) after
treatment (p=0.02). There was, however, no improvement in hearing status,
tinnitus, functional level or self-perceived dizziness handicap. Long-term (>1
year) follow-up data revealed that only 2 subjects preferred to continue Meniett
therapy and that ablative surgery had to be performed in 6/12 study patients.
-----
Acta Otolaryngol. 2005 Nov;125(11):1180-3.
Intratympanic gentamicin treatment after endolymphatic sac
surgery.
Gouveris H, Lange G, Mann WJ.
Department of Otolaryngology--Head and Neck Surgery, University of Mainz Medical
School, Mainz, Germany. gouveris@hno.klinik.uni-mainz.de
CONCLUSIONS: Interval treatment with up to three intratympanic gentamicin
injections once weekly effectively controlled vertigo while preserving hearing
in patients with Meniere's disease and recurrent or resistant vertigo after
saccotomy. OBJECTIVES: Recurrent or resistant incapacitating vertigo may occur
after endolymphatic sac surgery (saccotomy) in patients with Meniere's disease.
In these patients, revision saccotomy, vestibular nerve section or
labyrinthectomy are the established treatment options. We advocate a once-weekly
application of intratympanic gentamicin (12 mg) as an effective alternative in
this group of patients. MATERIAL AND METHODS: Five patients (age range 39-65
years) with definite Meniere's disease according to the 1995 American Academy of
Otolaryngology-Head and Neck Surgery (AAO-HNS) criteria and incapacitating
vertigo underwent gentamicin treatment after saccotomy. Control of vertigo and
hearing preservation were the aims of treatment. The follow-up period ranged
from 26 to 59 months. History and pure-tone audiometry were used to assess
vertigo control and hearing, respectively. The frequency of vertigo in the
6-month period before gentamicin treatment ranged between 0.5 and four
definitive episodes per month. Hearing stage (AAO-HNS criteria) before
gentamicin treatment ranged between 2 and 4. Pre- and post-treatment pure-tone
hearing thresholds at 0.5, 1, 2 and 3 kHz were compared by means of the
Mann-Whitney U-test. RESULTS: Complete vertigo control (class A; AAO-HNS) and
hearing preservation at 0.5, 1, 2 and 3 kHz were achieved.
-----
Expert Rev Med Devices. 2005 Sep;2(5):533-7.
Treatment of Meniere's disease with the low-pressure pulse
generator (Meniett device).
Gates GA.
University of Washington, Virginia Merrill Bloedel Hearing Research Center, 1959
NE Pacific Street, Seattle, WA 98195, USA. ggates@u.washington.edu
Until recently, surgery was the only treatment option for people with disabling
Meniere's disease that did not respond to adequate medical therapy. A new
intermediate level treatment modality, the Meniett device, which applies
low-pressure micropulses to the inner ear, has now been shown to be safe and
effective. The device is portable and self-administered, requiring a 5-min
three-times daily application for an indefinite period. Placement of a
tympanostomy tube in the ear drum of the affected ear is necessary. Patient
acceptance has been high. Long-term success in control of vertigo is over 80%.
Although hearing loss is not improved, Meniett device usage does not adversely
affect balance, as do most forms of surgical therapy. Use of the device does not
preclude later surgical therapy.
-----
Otol Neurotol. 2005 Sep;26(5):1022-6.
Oral administration of prednisone to control refractory vertigo
in Meniere's disease: a pilot study.
Morales-Luckie E, Cornejo-Suarez A, Zaragoza-Contreras MA, Gonzalez-Perez O.
Department of Otolaryngology, Hospital de Especialidades del Centro Medico
Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara,
Mexico.
OBJECTIVE: To establish whether the oral administration of moderate doses of
prednisone reduces refractory vertigo in Meniere's disease. STUDY DESIGN:
Blinded, randomized, controlled trial. SETTING: Tertiary referral center.
PATIENTS: Patients with Meniere's disease with limited vertigo control (Class C)
and severe disability (Scale 3). INTERVENTIONS: Two groups (n = 8 per group)
were treated orally with either diphenidol (25 mg/d) plus acetazolamide (250
mg/48 h) (control group), or the same treatment plus prednisone (0.35 mg/kg)
daily for 18 weeks (prednisone group). MAIN OUTCOME MEASURES: The variables
evaluated were the frequency and duration of vertigo, tinnitus, aural fullness,
and audiographic parameters. The clinical surveillance was performed for 12
months after prednisone withdrawal. RESULTS: The frequency and duration of
vertigo episodes were reduced by 50% and 30%, respectively, by prednisone
treatment. Prednisone-treated patients manifested a significant reduction in
tinnitus. No changes were observed in aural fullness or hearing. No metabolic or
infectious disorders were observed. CONCLUSION: Oral prednisone helps to control
refractory vertigo in Meniere's disease. These preliminary data suggest that
prednisone can be a good noninvasive antivertigo management regimen for these
patients.
-----
Otol Neurotol. 2005 Sep;26(5):890-5.
Intratympanic dexamethasone and hyaluronic acid in patients with
low-frequency and Meniere's-associated sudden
sensorineural hearing loss.
Selivanova OA, Gouveris H, Victor A, Amedee RG, Mann W.
Department of Otolaryngology, Head and Neck Surgery, University of Mainz Medical
School, Mainz, Germany. selivanova@hno.klinik.uni-mainz.de
BACKGROUND: Steroids are widely used for the treatment of cochleovestibular
disorders. Direct steroid application in the middle ear cavity, when combined
with a round window membrane permeability-modulating substance, increases the
level of the steroid reaching the target cells. We measured hearing in patients
with idiopathic isolated low-frequency sensorineural hearing loss and in
patients with sudden sensorineural hearing loss and a history of Meniere's
disease. Contradictory reports about effectiveness of intratympanic steroid
therapy on vertigo control and hearing improvement in patients with Meniere's
disease exist in the literature. METHODS: Eighteen patients with isolated
low-frequency idiopathic sudden sensorineural hearing loss and 21 patients with
sudden sensorineural hearing loss and a history of Meniere's disease were
prospectively evaluated. The acute effect of the intratympanic application of
dexamethasone with hyaluronic acid on hearing outcome after failure of an
initial standard treatment with intravenous steroid and vasoactive substances
was assessed. Evaluation was based on standard pure-tone audiometry findings.
RESULTS: After intratympanic injection of dexamethasone and hyaluronic acid, 14
of the 18 patients with isolated low-frequency sensorineural hearing loss showed
a significant improvement in hearing. After intratympanic therapy, 15 patients
with a previous history of Meniere's disease and idiopathic isolated
low-frequency sensorineural hearing loss showed an improvement in hearing on
pure-tone audiometry, four remained unchanged, and two showed a tendency toward
a slight deterioration. CONCLUSION: Intratympanic combined dexamethasone/hyaluronic
acid application provides a reliable and safe therapeutic option for improvement
of hearing in patients with isolated low-frequency idiopathic sudden
sensorineural hearing loss or sensorineural hearing loss resulting from
Meniere's disease who have failed intravenous steroid and vasoactive treatments.
-----
Otolaryngol Head Neck Surg. 2005 Sep;133(3):441-3.
Effects of intratympanic injection of latanoprost in Meniere's
disease: a randomized, placebo-controlled, double-blind, pilot study.
Rask-Andersen H, Friberg U, Johansson M, Stjernschantz J.
Department of Otosurgery, University Hospital, Uppsala, Sweden.
helge.rask-andersen@akademiska.se
OBJECTIVE: To determine the short-term effects of latanoprost, a selective FP
prostanoid receptor agonist, in Meniere's disease. STUDY DESIGN AND METHODS:
Latanoprost was administered by intratympanic injection once daily for 3 days.
Before the first injection (day 1) and on days 5 and 15, hearing and tinnitus
were determined. The patients assessed vertigo on a visual analogue scale on
days 1-15. The study was randomized, double-blind, and placebo-controlled.
RESULTS: Latanoprost reduced vertigo/dysequilibrium around 30% (P < 0.05), and
improved speech discrimination around 15% (P < 0.05). Tinnitus loudness
deteriorated after injection of placebo (P < 0.01) but not after latanoprost.
Side effects were few. CONCLUSION AND SIGNIFICANCE: Latanoprost alleviated
vertigo/dysequilibrium and improved hearing. The results indicate that the drug
potentially could be useful for treatment of Meniere's disease.
-----
Otolaryngol Head Neck Surg. 2005 Sep;133(3):326-8.
The role of vestibular rehabilitation in the treatment of
Meniere's disease.
Gottshall KR, Hoffer ME, Moore RJ, Balough BJ.
Department of Defense Spatial Orientation Center, Naval Medical Center San
Diego, CA 92134, USA. krgottshall@nmcsd.med.navy.mil
OBJECTIVE: To study the role of vestibular rehabilitation is treating patients
with Meniere's disease. METHODS: We examined all Meniere's patients presenting
to our tertiary care specialized vestibular clinic during a 1-year period. All
patients underwent a standardized history and physical examination, a complete
auditory-vestibular test battery, and a set of physical therapy tools to measure
balance function. RESULTS: A subset of patients suffered from disequilibrium or
unsteadiness between attacks. Once the acute fluctuating symptoms of Meniere's
were controlled in this group of individuals, all of them underwent vestibular
physical therapy and demonstrated significant improvement in balance function on
both objective and self-report tests. CONCLUSIONS: Due to the fluctuating nature
of the disorder, vestibular physical therapy has had a limited role in the
treatment of Meniere's disease. In general, rehabilitation has been used only as
a postoperative treatment for the acute vertigo seen after vestibular neurectomy
or labyrinthectomy. This is the first report advocating the role of vestibular
physical therapy in a group of patients receiving medical therapy of intraear
medicines (other that gentamicin).
-----
Laryngoscope. 2005 Aug;115(8):1454-7.
Endolymphatic sac decompression as a treatment for Meniere's
disease.
Durland WF Jr, Pyle GM, Connor NP.
Division of Otolaryngology-Head and Neck Surgery, Department of Surgery,
University of Wisconsin, 600 Highland Avenue, Madison, WI 53792, U.S.A.
OBJECTIVES/HYPOTHESIS: Endolymphatic sac decompression is a surgical treatment
option for patients with medically intractable Meniere's disease. However,
effectiveness is debated because published data show great variability.
Outcome-based research studies are useful in incorporating the patient's
perspective on the success of treatment. To further assess effectiveness of
endolymphatic sac decompression, we performed a prospective study to examine
both symptom-specific and general health outcomes. STUDY DESIGN: Prospective,
observational outcome study. METHODS: Nineteen patients with endolymphatic sac
decompression responded to symptom-specific questionnaires and the Medical
Outcomes Short-Form 36 Health Survey (SF-36) before and after surgery. Follow-up
ranged from 6 to 58 months with a mean duration of 50 months. RESULTS: Overall
measures of physical health were significantly improved following endolymphatic
sac decompression (P = .04), whereas overall measures of mental health were
unchanged (P = .74). Role Physical and Social Functioning scores were
significantly improved following endolymphatic sac decompression (P = .04 and P
= .03, respectively). Study patients scored significantly lower (P < .05) than
SF-36 normative data in 6 of 10 categories before endolymphatic sac
decompression but patient scores were not significantly different from normal
scores in all but one category (General Health) following endolymphatic sac
decompression. The mean number of vertigo episodes was significantly reduced
from an average of 8.3 times per month to an average of 2.6 times per month
following endolymphatic sac decompression (P = .006). Ninety-five percent of
patients (18 of 19 patients) reported improvement in symptoms (frequency,
duration, or intensity) of vertigo and 37% (7 of 19 patients) reported complete
resolution of vertigo. CONCLUSION: Endolymphatic sac decompression significantly
improved perception of physical health, as well as symptom-specific outcomes, in
patients with medically intractable Meniere's disease.
-----
Otolaryngol Head Neck Surg. 2005 Aug;133(2):285-94.
Dexamethasone inner ear perfusion by intratympanic injection in
unilateral Meniere's disease: a two-year prospective, placebo-controlled,
double-blind, randomized trial.
Garduno-Anaya MA, Couthino De Toledo H, Hinojosa-Gonzalez R, Pane-Pianese C,
Rios-Castaneda LC.
Department of Neurotology, National Institute of Neurology and Neurosurgery,
Mexico City, Mexico. mgardu@avantel.net
OBJECTIVE: To investigate the efficacy of dexamethasone inner ear perfusion by
intratympanic injection in hearing loss, tinnitus, aural fullness, and vertigo
in the treatment of unilateral Meniere's disease and compare it with the control
group. STUDY DESIGN AND SETTING: A prospective, randomized, double-blind study
with 2-year follow-up comparing changes secondary to dexamethasone inner ear
perfusion versus placebo consisting of saline solution. PATIENTS: Twenty-two
patients having definite Meniere's disease as outlined by the 1995 American
Academy of Otolaryngology-Head and Neck Surgery Committee on Hearing and
Equilibrium. All the patients were older than 18 years of age and were not
receiving any other form of treatment with steroids for their Meniere's disease.
METHOD: Five consecutive daily intratympanic injections of dexamethasone or
placebo to the involved ear. RESULTS: In the dexamethasone group at 2-year
follow-up, complete control of vertigo (class A) was achieved in 9 of 11
patients (82%) and substantial control of vertigo (class B) in the remaining 2
patients (18%.) In the control group only 7 of 11 patients (64%) finished the
2-year follow-up because in the other 4 patients (36%) we had to give another
treatment for the continuing vertigo and thus they were classified as failure
(class F.) From the 7 patients who have finished the follow-up of 2 years in the
control group, 4 patients (57%) achieved class A, 2 patients (29%) achieved
class C, and 1 patient (14%) class F. CONCLUSIONS: Dexamethasone (4 mg/mL) inner
ear perfusion in a group of patients with unilateral Meniere's disease (Shea's
stage III) showed 82% of complete control of vertigo over placebo (57%). There
was also a subjective improvement in tinnitus (48%), hearing loss (35%), and
aural fullness (48%) in the dexamethasone group compared with 20%, 10%, and 20%
respectively in the control group.
-----
J Laryngol Otol. 2005 May;119(5):391-5.
Long-term effects of the Meniett device in Meniere's disease: the
Western Australian experience.
Rajan GP, Din S, Atlas MD.
Lions Ear and Hearing Institute, Sir Charles Gairdner Hospital, University of
Western Australia, Australia. guneshrajan@hotmail.com
OBJECTIVES: Transtympanic pressure has been shown to influence endolymphatic
hydrops. As endolymphatic hydrops plays a key role in Meniere's disease, a few
studies, undertaken by the inventors, manufacturers and associates of the
Meniett device, have demonstrated positive short-term effects of transtympanic
pressure treatment via the Meniett device in medically intractable Meniere's
disease. The aim of our study was to independently investigate the long-term
efficacy and safety of transtympanic pressure treatment in the management of
recalcitrant vertigo in Meniere's disease. DESIGN: Cross-sectional case study.
SETTING: Tertiary referral centre. PARTICIPANTS: Eighteen patients with
Meniere's disease, suffering from medically intractable symptoms. All patients
in the study had Meniere's disease according to the criteria of the Committee on
Hearing and Equilibrium of the American Academy of Otolaryngology, Head & Neck
Surgery.Main outcome measurements: Outcome and severity of symptoms were
assessed, using the six-point functional scale and the vertigo visual analogue
scale (VAS), as recommended by the Committee on Hearing and Equilibrium of the
American Academy of Otolaryngology, Head & Neck Surgery. Changes of pure tone
average thresholds and vestibular calorics before and during treatment with the
Meniett device were recorded. The mean follow-up time was 18 months. RESULTS:
Twelve out of 18 patients showed significant improvement in the functional score
and in the VAS. Five patients displayed an audiometric improvement, out of which
three patients showed a pertaining significant hearing gain of more than 10 dB;
the remainder had stable hearing levels. Of six patients without any
improvement, four had previous invasive surgery for their Meniere's disease and
two had previous vestibular ablation with gentamicin. No changes in vestibular
function were noted. There were no complications during the treatment with the
Meniett device. CONCLUSION: According to this independent study, the Meniett
device seems to be a minimally invasive, non-destructive treatment tool, which
can reduce vertigo and associated functional handicap in Meniere's disease.
These effects are maintained up to 18 months after treatment so far. Previous
surgical or chemical vestibular ablation procedures may adversely influence the
effect of the Meniett device.
-----
Otolaryngol Head Neck Surg. 2005 May;132(5):722-6.
Trends in the diagnosis and the management of Meniere's disease:
results of a survey.
Kim HH, Wiet RJ, Battista RA.
Wilson Ear Clinic, 911 NW 18th Avenue, Portland, OR 97209, USA. galbey@yahoo.com
OBJECTIVE: To determine the practices of the American Neurotology Society (ANS)
membership in the evaluation and treatment of the Meniere's patient. STUDY
DESIGN: Prospective. INTERVENTION: Questionnaire. MAIN OUTCOME MEASURE:
Respondents' response to questions pertaining to the diagnostic and therapeutic
practices in the management of Meniere's disease. RESULTS: Three hundred members
of ANS were mailed a 15-item questionnaire. Two hundred three responded, for a
67.7% response rate. For the diagnosis of Meniere's disease, 1 in 3
practitioners relied solely on history, physical exam, and audiometry, whereas 2
in 3 relied in part on adjunctive tests, such as electrocochleography (ECOG) and
electronystagmography (ENG). Two in 3 practitioners pursued retrocochlear
studies on initial evaluation, with the overwhelming majority using MRI. In
treating Meniere's disease, conservative medical management was preferred. For
medically recalcitrant Meniere's disease, endolymphatic sac surgery (ESS) was
the most commonly employed initial intervention (50%), followed by transtympanic
gentamicin (38%). Currently, <10% routinely recommend the Meniett device.
Eighty-three percent include ESS as a therapeutic option for medically
recalcitrant Meniere's disease. The vast majority continue to perform surgical
labyrinthectomies and vestibular nerve sections for Meniere's disease.
CONCLUSIONS: Meniere's disease continues to pose a difficult diagnostic and
therapeutic problem, resulting in heterogeneous approaches to both evaluation
and treatment. Despite the 1995 American Academy of Otolaryngology guidelines in
the diagnosis of Meniere's disease, most clinicians rely in part on ENG or ECOG
in diagnosing Meniere's disease. Furthermore, despite the passing of 20 years
since the publications claiming a purely placebo effect, ESS is the most
commonly employed initial surgical treatment for Meniere's disease.
-----
J Vestib Res. 2005;15(1):49-58.
Vestibular function at the end of intratympanic gentamicin
treatment of patients with Meniere's disease.
Perez N, Rama-Lopez J.
Department of Otolaryngology, University Hospital and Medical School, University
of Navarra, Spain. nperezfer@unav.es
The aim of this study is to analyze the effects of intratympanic gentamicin
injections on vestibular function in 33 patients with unilateral Meniere's
Disease (according to AAO-HNS guidelines 1995) that had been unresponsive to
medical therapy for at least one year. In such patients, the results of bedside
examination of vestibular function vestibular examination is compared to those
from laboratory tests. Intratympanic gentamicin injections (27 mg/ml) were
performed at weekly intervals until symptoms or signs of vestibular hypofunction
developed in the treated ear. Vestibular function was evaluated in two different
rotatory chair tests. The parameters that were specifically considered were the
time constant of the vestibulo-ocular reflex (VOR) after impulse rotation with a
peak chair velocity of 100 degrees s(-1), and the phase and gain of the VOR
after the sinusoidal harmonic acceleration (SHA) test with a peak chair velocity
of 50 degrees s(-1). After treatment, both the time constant of the VOR after
rotation towards the treated side and the gain in the SHA test were
significantly reduced. These reductions were in accordance with the number of
additional signs observed upon bedside examination at the end of the treatment.
The changes observed in the VOR correlate well with the results of bedside
examination of vestibular function, which in turn reflects the damage induced by
intratympanic gentamicin injection.
-----
Am Fam Physician. 2005 Mar 15;71(6):1115-22.
Treatment of vertigo.
Swartz R, Longwell P.
Department of Family and Preventive Medicine, University of California, San
Diego, School of Medicine, La Jolla, California, USA. swartz.john2@scrippshealth.org
Vertigo is the illusion of motion, usually rotational motion. As patients age,
vertigo becomes an increasingly common presenting complaint. The most common
causes of this condition are benign paroxysmal positional vertigo, acute
vestibular neuronitis or labyrinthitis, Meniere's disease, migraine, and anxiety
disorders. Less common causes include vertebrobasilar ischemia and retrocochlear
tumors. The distinction between peripheral and central vertigo usually can be
made clinically and guides management decisions. Most patients with vertigo do
not require extensive diagnostic testing and can be treated in the primary care
setting. Benign paroxysmal positional vertigo usually improves with a canalith
repositioning procedure. Acute vestibular neuronitis or labyrinthitis improves
with initial stabilizing measures and a vestibular suppressant medication,
followed by vestibular rehabilitation exercises. Meniere's disease often
responds to the combination of a low-salt diet and diuretics. Vertiginous
migraine headaches generally improve with dietary changes, a tricyclic
antidepressant, and a beta blocker or calcium channel blocker. Vertigo
associated with anxiety usually responds to a selective serotonin reuptake
inhibitor.
-----
Acta Neurochir (Wien). 2005 Apr;147(4):401-4.
Retrosigmoid approach for vestibular neurectomy in Meniere's
disease.
Perez R, Ducati A, Garbossa D, Benech F, Fontanella MM, Canale A, Albera R.
Department of Neuroscience, Neurosurgery Section, University of Torino, Italy.
Background. Vestibular nerve section is considered to be the most effective
surgical procedure to control intractable symptoms secondary to Meniere's
disease (MD). This study was developed to analyze the adequacy of retrosigmoid
vestibular neurectomy in terms of vertigo control, hearing preservation and
clinical complications of this procedure.Methods. A retrospective review was
carried out on 14 patients affected by definite unilateral MD who underwent
vestibular neurectomy via the retrosigmoid approach.Findings. One patient was
lost from follow-up; another one had only a short postoperative observation. At
follow-up performed on 12 cases, no patients reported any crisis of acute
vertigo. Four patients were free from any vestibular symptoms, while 8 reported
some slight gait disturbances. Hearing function was preserved in 10 patients and
improved in 2. 1 year postoperative vestibular function was absent at the side
operated on and unchanged on the other side in all the cases.Conclusions.
Vestibular neurectomy via the retrosigmoid approach can be considered a safe and
effective procedure in relieving medically refractory vertigo in Meniere's
disease, while preserving hearing.
-----
Otolaryngol Head Neck Surg. 2005 Mar;132(3):443-50.
Surgical management of Meniere's disease in the era of gentamicin.
Kaylie DM, Jackson CG, Gardner EK.
Otology Group, Nashville, TN, USA. dkaylie@hotmail.com
OBJECTIVE: For many years, surgery was the mainstay of therapy for medically
refractory patients, but recently, transtympanic gentamicin perfusion has
attracted increasing interest and is a method frequently used for treating
Meniere's disease. Many otologists question the relevance of surgical
treatments, and traditional options are rarely discussed or offered to patients.
The purpose of this study is to describe results of labyrinthectomy, vestibular
nerve section, and endolymphatic mastoid shunt surgery for patients with
Meniere's disease and to compare them with published results for gentamicin
perfusion. STUDY DESIGN AND SETTING: Retrospective chart review. Two hundred
twenty-nine patients underwent surgery for management of Meniere's disease
between January 1, 1995 and December 31, 2001. One hundred eighty-nine patients'
charts had sufficient data for review. Thirty-two patients had translabyrinthine
labyrinthectomies, 83 underwent suboccipital vestibular nerve sections, and 74
elected for an endolymphatic mastoid shunt. Hearing results, dizziness
classification, and functional level score were determined from patient charts
and telephone conversations. All results were in accordance with the guidelines
of the AAO-HNS Committee on Hearing and Equilibrium for evaluation of Meniere's
disease therapy. RESULTS: Audiologic results, functional level score, and
dizziness classification are reported for the preoperative period and for the
18- to 24-month postoperative period for all surgical patients. These data are
also reported individually for each of the 3 surgical procedures. Early
postoperative data and most recent follow-up data are presented if available.
CONCLUSIONS: Surgical management of Meniere's disease is a safe and viable
option for patients with medically refractory disease. EBM rating: C.
-----
Curr Opin Neurol. 2005 Feb;18(1):23-8.
Surgical treatment of Meniere's disease.
Van de Heyning PH, Wuyts F, Boudewyns A.
University Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp
University Hospital, Antwerp, Belgium. Paul.van.de.heyning@uza.be
PURPOSE OF REVIEW: This review comprises new insights from and discusses the
impact of recent medical publications on the surgical treatment of Meniere's
disease. RECENT FINDINGS: Refining surgical indications through recognition of
clinical conditions with similar symptoms and through a more precise estimation
of the degree of disability will improve the process of decision making for
surgery. Further high-level evidence-based medical data supporting the
effectiveness of intratympanic gentamycin has become available.
Physiopathological progress, based on animal experiments, towards surgically
applied intracochlear drug delivery is addressed. SUMMARY: Studies using level 1
or 2 evidence-based medicine must be conducted to enable better decision making,
such as in the application of intratympanic gentamycin or micropressure Meniett
therapy at an earlier stage of Meniere's disease. If the results of such studies
are conclusive for surgery, this will lead to a shorter duration of discomfort
for patients before being offered the possibility of surgery.
-----
Curr Opin Neurol. 2005 Feb;18(1):11-4.
Pharmacology of vertigo/nystagmus/oscillopsia.
Straube A.
Department of Neurology, University of Munich, Munich, Germany. astraube@brain.nefo.med.uni-muenchen.de
PURPOSE OF REVIEW: To describe recent developments in the pharmacological
treatment of vertigo and nystagmus while focusing on vestibular neuritis,
Meniere's disease, downbeat nystagmus, periodic alternating nystagmus, acquired
pendular nystagmus, and superior oblique myokymia. RECENT FINDINGS: In the last
2 years several studies have been published on possible pharmacological
treatment options for nystagmus and oscillopsia. In the treatment of vestibular
neuritis two studies showed that cortisone treatment was effective for restoring
labyrinthine function. This benefit seems more likely if treatment is started
within the first 2 days of onset. For recurrent vertigo attacks due to Meniere's
disease, the titration technique with daily or weekly doses of intratympanic
gentamicin until onset of vestibular symptoms, change in vertigo or hearing loss
rated best for complete vertigo control. A new pharmacological treatment option
for downbeat nystagmus is the administration of potassium channel blockers (e.g.
4-aminopyridine). They are thought to reinforce the inhibitory action of
cerebellar Purkinje cells. Several case reports have proven the beneficial
effect of baclofen on periodic alternating nystagmus, of gabapentin and
memantine on acquired pendular nystagmus, and of carbamazepine and gabapentin on
superior oblique myokymia. SUMMARY: There have been several new developments in
the treatment of nystagmus and vertigo over the last 2 years. These include
potassium channel blockers for the treatment of downbeat nystagmus, early
cortisone treatment to improve recovery of the labyrinth function in vestibular
neuritis, and intratympanic gentamicin treatment for Meniere's disease. Other
pharmacological treatment options are baclofen for periodic alternating
nystagmus, gabapentin and memantine for acquired pendular nystagmus, and
carbamazepine for superior oblique myokymia.
-----
Otol Neurotol. 2005 Jan;26(1):68-73.
Local overpressure treatment reduces vestibular symptoms in
patients with Meniere's disease: a clinical, randomized, multicenter,
double-blind, placebo-controlled study.
Thomsen J, Sass K, Odkvist L, Arlinger S.
Department of Otolaryngology/Head & Neck Surgery, Gentofte University Hospital,
Hellerup, Denmark. jetho@gentoftehosp.kbhamt.dk
OBJECTIVES: To evaluate the efficacy of a new device, the Meniett, in the
treatment of Meniere's disease. The device delivers pressure pulses to the
middle ear through a ventilating tube in the tympanic membrane at a frequency of
6 Hz for 0.6 second. After rising to a pressure level of 1.2 kPa, the pressure
oscillates between 0.4 and 1.2 kPa. It is believed that the pressure changes are
conveyed to the inner ear, inducing a transport of fluids via the pressure
outlets and thus reducing the endolymphatic hydrops. STUDY DESIGN: A clinical,
randomized, multicenter, double-blind, placebo-controlled study. A total of 40
patients were included that had active Meniere's disease according to American
Academy of Otolaryngology-Head and Neck Surgery criteria, aged between 20 and 65
years, with a history of at least eight attacks during the past year. After
insertion of the ventilation tube, the patients should have had attacks of
vertigo for 2 months before entering the study. OUTCOME MEASURES: Primary study
endpoints were change in frequency of vertigo, change of functionality profile,
and change in patient perception of vertigo (visual analogue scale); secondary
endpoints were perception of tinnitus, aural pressure, and hearing, as well as
an audiologic evaluation of hearing before and after the treatment period.
RESULTS: The functionality level improved statistically significantly in the
active group compared with the placebo group (p=0.0014), as did the visual
analogue scale evaluation of vertigo (p=0.005). There was a trend toward a
reduction of the frequency of vertiginous attacks that was not significant
(p=0.090). With regard to the secondary endpoints, there was no statistical
difference between active and placebo groups. CONCLUSION: Local overpressure
treatment is a novel treatment that is noninvasive, nondestructive, and safe. It
significantly reduces vestibular symptoms in patients with Meniere's disease.
The Meniett was cleared by the Food and Drug Administration in 2000.
-----
Otolaryngol Head Neck Surg. 2004 Dec;131(6):877-84.
Randomized double-blinded, placebo-controlled clinical trial of
famciclovir for reduction of Meniere's disease symptoms.
Derebery MJ, Fisher LM, Iqbal Z.
Objective To conduct a clinical trial of famciclovir for symptom control in
Meniere's disease. Study design and setting Randomized, double-blinded
placebo-controlled clinical trial in a tertiary referral center, with 12
subjects in the active treatment arm and 11 subjects in the placebo arm. Results
There were no serious adverse events. Twenty-five percent of the famciclovir
group and 18% of the placebo group showed a reduction in number of vertigo
spells, the primary efficacy endpoint. This difference was not statistically
significant. All subjects improved in dizziness and health-related quality of
life. There was a trend for the famciclovir arm to have less fluctuation in
hearing relative to the placebo arm. Conclusion No dramatic effects of
famciclovir were found on vertigo or dizziness. Some promising effects on
reduction of the fluctuation in hearing were observed. Significance Famciclovir
may suppress the fluctuation of hearing in Meniere's disease, but had a minimal
effect on vertigo or dizziness symptoms in this study. The probable
multifactorial etiology in Meniere's disease requires that further studies be
conducted to determine the effects of antiviral medications. EBM rating: A.
-----
Laryngoscope. 2004 Dec;114(12):2085-2091.
Intratympanic Gentamicin for Meniere's Disease: a Meta-Analysis.
Cohen-Kerem R, Kisilevsky V, Einarson TR, Kozer E, Koren G, Rutka JA.
>From the Department of Otolaryngology-Head and Neck Surgery (r.c.-k.) and the
Division of Clinical Pharmacology and Toxicology (r.c.-k., e.k., g.k.), Hospital
for Sick Children, Toronto, Canada; the Department of Otolaryngology-Head and
Neck Surgery (v.k., j.a.r.), University Health Network, Toronto General
Hospital, Toronto, Canada; and the Leslie Dan Faculty of Pharmacy and University
of Toronto (t.r.e.), Toronto, Canada.
OBJECTIVES:: To systematically review the published experience on intratympanic
gentamicin treatment for intractable Meniere's disease. STUDY DESIGN::
Meta-analysis using a random effect model. METHODS:: A comprehensive literature
search was performed for articles using intratympanic gentamicin as a sole
treatment modality with reporting of results according to the American Academy
of Otolaryngology Head and Neck Surgery (AAO-HNS) guidelines for Meniere's
disease. Two reviewers independently assessed trial quality and extracted data.
RESULTS:: Fifteen trials with 627 patients met the inclusion criteria. All
trials reported "before-after" outcome measures, using patients as their own
controls. No double-blind or blinded prospective control trials were identified.
Complete (class A) vertigo control was achieved in 74.7% (confidence interval
[CI]95% 67.8-81.5%) of patients, and complete or substantial (class B) control
was achieved in 92.7% (CI95% 89.5-96.0%). The success rate was not affected by
gentamicin treatment regimen (fixed vs. titration). Hearing level and word
recognition were not adversely affected, regardless of gentamicin treatment
regimen. Analysis of functional level was not performed because of lack of data
in the selected articles. CONCLUSIONS:: Intratympanic gentamicin treatment for
intractable Meniere's disease appears to be effective in the relief of vertigo.
Cochleotoxicity and ototoxicity is unlikely to be a major side effect. However,
the level of evidence reflected from the eligible articles is insufficient,
especially because of relatively poor study design. Therefore, it is prudent
that patients eligible for this type of treatment should be selected carefully
and titrated with low-dose gentamicin. Further investigation with this treatment
modality with control subjects is warranted.
-----
Otol Neurotol. 2004 Nov;25(6):1034-1039.
Intratympanic Steroid Treatment: A Review.
Doyle KJ, Bauch C, Battista R, Beatty C, Hughes GB, Mason J, Maw J, Musiek FL.
*Department of Otolaryngology-Head and Neck Surgery, University of California
Davis, Sacramento, California, U.S.A., daggerMayo Clinic, Rochester, MN, U.S.A.,
double daggerRush Medical Center, Chicago, IL, U.S.A., section signCleveland
Clinic, Cleveland, OH, U.S.A., and University of Connecticut, Storrs, CT, U.S.A.
OBJECTIVE:: To review published literature regarding the use of intratympanic
steroids in the treatment of Meniere's disease and sudden sensorineural hearing
loss and to make recommendations regarding their use based on the literature
review. DATA SOURCES:: Literature review from 1996 to 2003, PubMed, Medline
Plus, and Web of Science. STUDY SELECTION:: Retrospective case series and
uncontrolled prospective cohort studies were the only types of studies available
for review. CONCLUSION:: On the basis of the available literature, a weak
recommendation is made to use intratympanic steroid treatment of sudden hearing
loss if oral steroid therapy fails or is con-traindicated. The available studies
regarding intratympanic steroid treatment of Meniere's disease and tinnitus are
inadequate to answer the question of the efficacy of this treatment for these
conditions. Higher quality studies are needed.
-----
Int Tinnitus J. 2004;10(1):54-7.
Ozone therapy and pressure-pulse therapy in Ménière's disease.
Pawlak-Osinska K, Kazmierczak H, Kazmierczak W, Szpoper M.
Audiological and Vestibular Laboratory, E. Warminski's City Hospital, Poland.
osinskak1@wp.pl
The aim of this study was to evaluate the usefulness of ozone and pressure-pulse
therapies in treating Meniere's disease. Using objective otoacoustic emissions
and short-increment sensitivity index (SISI) tests together with subjective
anamnesis, we tested 15 patients (8 men, 7 women) who had suffered from
Meniere's disease for 1-3 years and had permanent sensorineural hypoacusis; we
compared results before and after treatment. We performed ozone therapy and
pressure-pulse treatments simultaneously for one 10-minute session each day for
10 consecutive days. After treatment, both otoacoustic-spontaneous and
transiently evoked emissions and SISI test results exhibited no statistically
significant changes. However, the subjective state of the patients was clearly
improved. The frequency, severity of attacks, and tinnitus decreased. The
mechanism of such an improvement is discussed.
-----
Lin Chuang Er Bi Yan Hou Ke Za Zhi. 2004 Jul;18(7):385-7.
[Intratympanic dexamethasone injections for intractable Meniere's
disease]
[Article in Chinese]
Lu Y, Ren J, Wu W, Yin T, Yang X, Xie D.
Department of Otorhinolaryngology, the Second Hospital of Xiangya Medical
College, Central South University, Changsha, 410011, China.
OBJECTIVE: To investigate the efficacy of intratympanic dexamethasone injections
(IDI) for 15 patients with intractable Meniere's disease (MD). METHOD:
Dexamethasone (2.5 mg/0.5 ml) was injected into the middle ear and followed by a
second injection 15 minutes later. The injection was repeated the next day and
weekly for 3 weeks. Total dose of dexamethason was 17.5 mg. RESULT: The 15
patients were followed up for 18 months (average). Complete relief of vertigo
was maintained in 10 cases, improved in 2 case, injection wos repeatad 3
patients with recurrent vertigo resulted in control of vertigo. Tinnitus
disappeared in 5 cases, reduced in 5 cases, unchanged in 5 cases. Hearing was
improved in 10 cases, unchanged in 5 cases. CONCLUSION: IDI is effective for
intractable MD. The benefits of IDI are avoidance of systemic use of steroids,
lower cost, easy application. IDI can be used as an initial surgical treatment
for persistent vertigo in MD and indicated for bilateral MD.
-----
J Laryngol Otol. 2004 Jul;118(7):489-95.
Long-term results of gentamicin inner ear perfusion in Meniere's
disease.
Suryanarayanan R, Cook JA.
Department of Otolaryngology and Leicester Balance Centre, Leicester Royal
Infirmary, Leicester, UK.
Chemical perfusion of the inner ear is an increasingly popular treatment for
Meniere's disease. The authors report on the long-term results of 22 patients
treated with gentamicin delivered via a round window micro-catheter. Patients
with Meniere's disease underwent continuous, low dose (10 mg/ml) gentamicin
infusion at 5 microlitre per hour for 10 days, through a micro-catheter placed
into the round window niche. Vertigo was controlled in 95 per cent, whilst
preserving hearing in 77 per cent. Hearing improved in three patients. Three
patients with pre-operative serviceable hearing (PTA < 50 db) demonstrated
reduced hearing; two patients with pre-operative non-serviceable hearing
developed a dead ear. Tinnitus and aural fullness remained unchanged or improved
in 86 per cent and 68 per cent respectively. Long-term vertigo control can be
achieved using low dose gentamicin, whilst preserving hearing and vestibular
function in the majority of patients. This procedure appears to stabilize the
vestibular function, enhancing the chance of effective vestibular
rehabilitation.
-----
Otol Neurotol. 2004 Jul;25(4):544-52.
Intratympanic gentamicin therapy for Meniere's disease: a
meta-analysis.
Chia SH, Gamst AC, Anderson JP, Harris JP.
Division of Otolaryngology, Head and Neck Surgery, Department of Surgery, School
of Medicine, University of California at San Diego, USA.
OBJECTIVE: This study compared the effectiveness of five different techniques of
intratympanic gentamicin administration for Meniere's disease. DATA SOURCES: A
MEDLINE search of the English language literature from 1978 to 2002 was
performed using the key words "intratympanic," "gentamicin," "therapy," "Meniere's,"
and "disease." STUDY SELECTION: Inclusion criteria to select articles for
meta-analysis were clear description of gentamicin delivery technique, clearly
reported vertigo control results, and report of hearing loss posttreatment.
Seven studies (n = 218) describing the multiple daily dosing technique (delivery
three times per day for >or=4 d), two studies (n = 84) describing the weekly
dosing technique (weekly injections for four total doses), eight studies (n =
253) of the low-dose technique (one to two injections with retreatment for
recurrent vertigo), four studies (n =156) of continuous microcatheter delivery,
and six studies (n =269) of the titration technique (daily or weekly doses until
onset of vestibular symptoms, change in vertigo, or hearing loss) were entered
into the model. DATA EXTRACTION: Vertigo control results were stratified into
complete, substantial, or poor control. Hearing results were separated by
profound, partial, or no hearing loss. Individuals undergoing caloric testing
were separated by degree of vestibular ablation (complete versus partial) and
analyzed for vertigo control (n = 301) and hearing loss (n = 333) after
treatment. DATA SYNTHESIS: Comparisons between the rates of complete vertigo
control, effective vertigo control (complete plus substantial control), overall
hearing loss (partial plus profound), and profound hearing loss by delivery
method were based on a parametric empirical Bayes analysis using binomial
generalized linear models and backward variable selection (joining). Relative
risk for vertigo control and hearing loss by partial or complete ablation was
examined study by study using residual maximum likelihood to carry out a
parametric empirical Bayes analysis. CONCLUSION: The titration method of
gentamicin delivery demonstrated significantly better complete (81.7%, p =
0.001) and effective (96.3%, p < 0.05) vertigo control compared with other
methods. The low-dose method of delivery demonstrated significantly worse
complete vertigo control (66.7%, p < 0.001) and trends toward worse effective
vertigo control (86.8%, p = 0.05) compared with other methods. The weekly method
of delivery trends toward less overall hearing loss (13.1%, p = 0.08), and the
multiple daily method demonstrated significantly more overall hearing loss
(34.7%, p < 0.01) compared with other groups. No significant difference in
profound hearing loss was found between groups. Degree of vestibular ablation
after gentamicin therapy is not significantly correlated with the resulting
vertigo control or hearing loss status.
-----
Ear Nose Throat J. 2004 Jun;83(6):394-8.
Intratympanic steroid perfusion for the treatment of Meniere's
disease: a retrospective study.
Dodson KM, Woodson E, Sismanis A.
Department of Otolaryngology Head and Neck Surgery, Virginia Commonwealth
University Medical Center, Richmond, VA 23298-0146, USA. kelleydodson@comcast.net
We conducted a retrospective outcomes review of the charts of 22 patients with
Meniere's disease who were treated with intratympanic perfusion of
methylprednisolone and/or dexamethasone. Outcomes were determined by subjective
assessment of vertigo control and by objective changes in audiometric pure-tone
average (PTA) and speech discrimination score (SDS). These evaluations were made
at the first postperfusion visit (short term) and at least 12 months later (long
term). In the short term, 12 patients (54.5%) achieved vertigo control, 4
patients (18.2%) demonstrated a greater than 10-dB improvement in PTA, and 1
patient (4.5%) experienced an increase in SDS of at least 15%. In the long term,
the corresponding numbers of patients were 4 (18.2%), 2 (9.1%), and 1 (4.5%).
The level of hearing ultimately deteriorated in 9 patients (40.9%). These
findings suggest that intratympanic steroid perfusion does not result in any
long-term alleviation of vertigo or hearing loss. However, the short-term
alleviation of vertigo seen in approximately half of these patients suggests
that this treatment may be useful for the temporary relief of symptoms of
Meniere's disease.
-----
Arch Otolaryngol Head Neck Surg. 2004 Jun;130(6):718-25.
The effects of transtympanic micropressure treatment in people
with unilateral Meniere's disease.
Gates GA, Green JD Jr, Tucci DL, Telian SA.
Department of Otolaryngology-Head and Neck Surgery, University of Washington
School of Medicine, Seattle, USA. ggates@u.washington.edu
OBJECTIVE: To evaluate the efficacy of a portable low-intensity alternating
pressure generator, the Meniett device, in controlling the symptoms of Meniere's
disease. DESIGN: A randomized, placebo-controlled, double-blind, multicenter
clinical trial of 4 months' duration. SETTING: Four study sites: 3 academic
medical centers and 1 private practice. PATIENTS: Sixty-seven people aged 33 to
71 years with established, active, unilateral cochleovestibular Meniere's
disease randomly assigned to a treatment or control group. Five cases were
excluded (2 dropouts, 3 protocol violations), leaving 62 evaluable cases.
INTERVENTION: The Meniett device was self-administered 3 times daily. The
placebo Meniett device was identical but exerted no pressure. All participants
had a tympanostomy tube inserted in the affected ear. MAIN OUTCOME MEASURES:
Participants rated vertigo and activity each day on a symptom report card.
Hearing tests, electrocochleography, and questionnaires were completed at
baseline, 2 months, and 4 months. RESULTS: The treatment group experienced
significantly less severe vertigo, fewer days with definitive vertigo, and fewer
days lost from work (sick days) during the follow-up period than did the control
group. Hearing and electrocochleographic results did not differ between the
groups. Outcomes did not differ by age, gender, laterality, or duration of
symptoms. Outcomes were affected by vestibular loss and baseline level of
vertigo. The tympanostomy tube had no short-term effect on vertigo symptoms.
There were no complications from using the Meniett device. CONCLUSION: The
Meniett device is a minimally invasive, safe, and efficacious intermediate
treatment for people with substantial vertigo uncontrolled by medical therapy.
-----
Ann Otol Rhinol Laryngol. 2004 May;113(5):399-403.
Surgical management of special cases of intractable Meniere's
disease: unilateral cases with intact canals and bilateral cases.
Kitahara T, Kondoh K, Morihana T, Okumura S, Mishiro Y, Kubo T.
Department of Otolaryngology and Sensory Organ Surgery, Osaka University
Graduate School of Medicine, Osaka, Japan.
If a clinician seeks to allow patients with vertigo to return to work as soon as
possible, it is very important to determine the appearance of vestibular
symptoms during convalescence just after treatment, as well as the long-term
results. Apprehensive patients with vertigo may undergo severe psychological
torment if treatment requires long-term rest in bed before they can return to
daily life. In this paper, we observed postoperative vestibular symptoms
(subjective sensation and objective nystagmus) in 50 patients with intractable
Meniere's disease, including cases from our previous preliminary report, during
the period of convalescence just after endolymphatic sac drainage and steroid
instillation surgery (EDSS). All symptoms were eliminated within 8 days after
EDSS. There was no significant difference in the duration of any vestibular
symptoms between bilateral (n = 8) and unilateral cases (n = 42). This result
indicates that EDSS could be as safe a treatment for bilateral Meniere's disease
as for unilateral disease. In unilateral cases with intact semicircular canal
function (n = 17), postoperative evoked vestibular sensation, positional, and
positioning (Dix-Hallpike) nystagmus disappeared significantly earlier than in
those with canal paresis (n = 25). This result indicates that EDSS could keep
the vestibular peripheral function of patients with unilateral Meniere's disease
with intact canals quite stable after surgery. Therefore, EDSS could be
recommended as an initial, less-invasive surgical treatment for intractable
Meniere's disease, especially in unilateral cases with intact canals and in
bilateral cases.
-----
Otol Neurotol. 2004 May;25(3):339-344.
Evaluating Quality of Life after Endolymphatic
Sac Surgery: The Meniere's Disease Outcomes Questionnaire.
Kato BM, LaRouere MJ, Bojrab DI, Michaelides EM.
*Kaiser Permanente Medical Center, Union City, California, and
daggerMichigan Ear Institute, Farmington Hills, Michigan, U.S.A.
OBJECTIVE:: To develop a disease-specific instrument to measure
the quality of life in patients with Meniere's disease and to
assess quality-of-life outcomes after endolymphatic sac decompression.
STUDY DESIGN:: Retrospective survey. PATIENTS:: Patients with
Meniere's disease who underwent endolymphatic sac decompression
from June 1996 to June 2001, after failing a course of medical
management. Two hundred fifteen potential subjects were identified;
completed questionnaires were returned by 159 patients. MAIN OUTCOME
MEASURES:: The Meniere's Disease Outcomes Questionnaire was developed,
and consists of questions in three domains that determine quality
of life: physical, emotional, and social well-being. The Meniere's
Disease Outcomes Questionnaire consisted of 18 multiple-choice
questions that were paired for pre- and postoperative conditions,
and one global quality-of-life question. The preoperative quality-of-life
score (total score for preoperative items) was compared with the
postoperative quality-of-life score. The main outcomes measure
was the change in quality-of-life score. RESULTS:: Overall, the
mean change in quality-of-life score was +25.6 points (range,
-34 to 83) (p < 0.001). The change in Meniere's Disease Outcomes
Questionnaire quality-of-life score was highly correlated with
the change in the global question score (p < 0.01). Quality
of life was improved in 87% of respondents, unchanged in 3% of
patients, and poorer in 9% of patients after endolymphatic sac
decompression. CONCLUSIONS:: The Meniere's Disease Outcomes Questionnaire
is a new disease-specific quality-of-life tool that is a valid
measure of quality of life in patients with Meniere's disease,
and is responsive to measuring change in quality of life after
treatment. Significant improvement in quality of life was reported
by 87% of patients after endolymphatic sac decompression.
-----
Acta Otolaryngol. 2004 Mar;124(2):172-5.
Selective vestibular ablation by intratympanic
gentamicin in patients with unilateral active Meniere's disease:
a prospective, double-blind, placebo-controlled, randomized clinical
trial.
Stokroos R, Kingma H.
Department of Otorhinolaryngology/Head and Neck Surgery, University
Hospital Maastricht, The Netherlands. rsto@skno.azm.nl
OBJECTIVE: To establish the efficacy of intratympanic gentamicin
treatment in patients with unilateral Meniere's disease. MATERIAL
AND METHODS: This was a prospective, double-blind, randomized
clinical trial of intratympanic gentamicin versus intratympanic
buffer solution (placebo) in patients with established active
Meniere's disease in the affected ear. Outcome measures included
the number of vertiginous spells, degree of sensorineural hearing
loss, labyrinthine function and labyrinthine asymmetry. RESULTS:
Topical gentamicin provided a significant reduction in the number
of vertiginous spells, although a "placebo effect" was
also observed. Sensorineural hearing loss did not occur in the
gentamicin group, although some deterioration occurred in the
placebo group. CONCLUSIONS: Intratympanic gentamicin is a safe
and efficient treatment for the vertiginous spells associated
with Meniere's disease. When applied early in the course of the
disease, it may prevent some of the sensorineural hearing deterioration
associated with it.
-----
Neurol Sci. 2004 Mar;25 Suppl 1:S26-30.
The treatment of acute vertigo.
Cesarani A, Alpini D, Monti B, Raponi G.
ENT Department, University of Milan, Milan, Italy.
Vertigo and dizziness are very common symptoms in the general
population. The aim of this paper is to describe the physical
and pharmacological treatment of symptoms characterized by sudden
onset of rotatory vertigo. Acute vertigo can be subdivided into
two main groups: (1) spontaneous vertigo and (2) provoked vertigo,
usually by postural changes, generally called paroxysmal positional
vertigo (PPV). Sudden onset of acute vertigo is usually due to
acute spontaneous unilateral vestibular failure. It can be also
fluctuant as, e.g., in recurrent attacks of Meniere's disease.
Pharmacotherapy of acute spontaneous vertigo includes Levo-sulpiride
i.v., 50 mg in 250 physiologic solution, once or twice a day,
methoclopramide i.m., 10 mg once or twice a day, or triethilperazine
rectally, once or twice a day, to reduce neurovegetative symptoms;
diazepam i.m., 10 mg once or twice a day, to decrease internuclear
inhibition, sulfate magnesium i.v., two ampoules in 500 cc physiological
solution, twice a day, or piracetam i.v., one ampoule in 500 cc
physiological solution, twice a day, to decrease vestibular damage.
At the onset of the acute symptoms, patients must lie on their
healthy side with the head and trunk raised 20 degrees. The room
must be quiet but not darkened. If the patient is able to swallow
without vomiting, it is important to reduce nystagmus and stabilize
the visual field with gabapentine, per os, 300 mg twice or three
times a day. The first step of the physical therapy of acute vertigo
is vestibular electrical stimulation, that is to say, a superficial
paravertebral electrical stimulation of neck muscles, aimed to
reduce antigravitary failure and to increase proprioceptive cervical
sensory substitution. PPV is a common complaint and represents
one of the most common entities in peripheral vestibular pathology.
While the clinical picture is well known and widely described,
the etiopathogenesis of PPV is still a matter of debate. Despite
the different interpretation of PPV etiopathogenesis, the maneuvers
described by Semont, Epley, or Lempert and their modifications
are undoubtedly effective. For this reason the first therapeutic
approach in acute provoked vertigo must be by means of one of
these kinds of treatments.
-----
Curr Opin Neurol. 2004 Feb;17(1):9-16.
Meniere's disease.
Minor LB, Schessel DA, Carey JP.
Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins
University School of Medicine, Baltimore, Maryland 21287-0910,
USA. lminor@jhmi.edu
PURPOSE OF REVIEW: Meniere's disease is characterized by spontaneous
attacks of vertigo, fluctuating sensorineural hearing loss, aural
fullness, and tinnitus. The pathologic process involves distortion
of the membranous labyrinth with the formation of endolymphatic
hydrops. This review describes the pathogenesis and etiology as
well as the diagnosis and treatment of Meniere's disease. RECENT
FINDINGS: Initial management of Meniere's disease can involve
a low-salt diet and a diuretic. Treatment with intratympanic injection
of gentamicin can be beneficial when vertigo persists despite
optimal medical management. Recent studies have shown that gentamicin
reduces vestibular function in the treated ear, although complete
ablation of this vestibular function is not typically required
in order to achieve control of vertigo. SUMMARY: Vertigo is often
the most debilitating symptom associated with Meniere's disease.
Many treatment options exist for the management of vertigo. Intratympanic
injection of gentamicin (low dose) can be used in patients for
whom vertigo has not been controlled by medical measures. Ongoing
research is providing a greater understanding of the effects of
gentamicin on vestibular function and of the mechanisms through
which gentamicin leads to control of vertigo.
-----
Laryngoscope. 2004 Feb;114(2):216-22.
Vestibular nerve section versus intratympanic
gentamicin for Meniere's disease.
Hillman TA, Chen DA, Arriaga MA.
Pittsburgh Ear Associates, 429 East North Avenue, Suite 422, Pittsburgh,
PA, USA.
OBJECTIVES/HYPOTHESIS:Vestibular nerve section and transtympanic
gentamicin administration are procedures with proven efficacy
in the treatment of vertigo associated with Meniere's disease
refractory to medical management. Hearing loss is a known complication
of each of these procedures; however, there has not been a report
of hearing results of both treatments from a single institution.
STUDY DESIGN: Retrospective review. METHODS: Review was made of
25 patients undergoing gentamicin injection and 39 patients undergoing
vestibular nerve section for Meniere's disease. Rate of vertigo
control and pretreatment and post-treatment pure-tone average
values and speech discrimination scores were reported. RESULTS:
The mean preoperative pure-tone average for patients having vestibular
nerve section was 47.2 dB, with a speech discrimination score
of 75.4%. In these patients, the postoperative pure-tone average
was 49.1 dB and the speech discrimination score was 75%. Patients
undergoing gentamicin injection had a mean pretreatment pure-tone
average of 55.9 dB and a speech discrimination score of 62%. The
post-treatment pure-tone average and speech discrimination score
for the gentamicin group were 68.8 dB and 49.3%, respectively.
Five of 25 patients (20%) in the gentamicin treatment group and
1 of 39 (3%) in the vestibular nerve section treatment group had
an increase in bone-conduction threshold greater than 30 dB. The
amount of postprocedure hearing loss was significantly greater
in the gentamicin treatment group (P =.006). Control of vertigo
was good to excellent in 95% of the patients treated with vestibular
nerve section and in 80% of the patients treated with gentamicin.
CONCLUSION: Although vestibular nerve section and transtympanic
gentamicin are both acceptable treatment options for vertigo associated
with Meniere's disease, gentamicin causes a higher level of hearing
loss related to treatment and vestibular nerve section has higher
vertigo control rates.
-----
Harefuah. 2004 Jan;143(1):4-7, 88.
[Intratympanic gentamicin treatment for intractable
Meniere's disease]
[Article in Hebrew]
Gilony D, Wolf M, Kronenberg J.
Departments of Otorhinolaryngology, Head & Neck Surgery, Chaim
Sheba Medical Center, Tel Hashomer.
BACKGROUND: Intratympanic gentamicin is an accepted mode of
treatment for patients with Meniere's disease who suffer from
recurrent vertigo attacks in spite of conservative medical treatment.
Recently, it gained popularity as the primary treatment for intractable
Meniere's disease, prior to surgical procedures. However, administration
methods and treatment protocols still differ from one medical
center to another. OBJECTIVES: We aimed to present outcomes of
gentamicin treatment for vertigo attacks and functional capacity,
based on our experience with 23 patients over 3 years and review
the literature on the subject. METHODS: Three specially prepared
gentamicin injections, were administered once a month, according
to the state of vertigo attacks, functional capacity, and hearing
status. Clinical observation, frequent hearing examinations and
caloric tests were used for follow-up. RESULTS: Following treatment,
20 (87%) patients no longer experienced vertigo attacks, while
16 of them (69.6%) reported full functional recovery. Two patients
(8.7%) did not respond to treatment, and therefore, underwent
surgical procedures. One patient (4.4%) did not complete therapy.
Post treatment caloric tests showed significant deterioration
(P < 0.02). Severe vestibular weakness (51-100%) was found
in the treated ear in 11 of the 14 patients with unilateral disease
(78.6%). The mean change in hearing examination was non-significant.
However, two of the 21 patients suffered a change from moderate
to severe hearing loss to complete deafness (9.5%). There was
no case of post treatment infection or permanent tympanic perforation.
CONCLUSIONS: Intratympanic gentamicin injection is a simple and
safe procedure for intractable Meniere's patients, with a high
success rate and low risk for hearing deterioration. It is recommended
for patients with continuous functional disability prior to surgical
treatment.
-----
Laryngoscope. 2004 Jan; 114(1): 102-5.
Long-term results after interval therapy with
intratympanic gentamicin for Meniere's disease.
Lange G, Maurer J, Mann W.
Department of Otorhinolaryngology, University of Mainz, Medical
School, Germany.
OBJECTIVES: The new single-shot and interval treatment for
Meniere's disease with gentamicin was designed to avoid cochlear
damage during treatment with gentamicin. METHODS: To date, 90
patients were treated with the single-shot or interval gentamicin
therapy. Fifty-seven cases of Meniere's disease were followed
up prospectively between 2 and 4 years. During one treatment series,
a maximum of three intratympanic gentamicin injections within
15 days were applied, each consisting of 0.3 mL (12 mg) of gentamicin
(days 1, 8, and 15). Thirty of these 57 patients (53%) needed
only one injection to be controlled (single-shot treatment). RESULTS:
Vertigo attacks were completely controlled in 95% and partially
controlled in 5%, whereas hearing remained unchanged or even improved.
Tinnitus as well as aural fullness were controlled in approximately
50% of the cases. CONCLUSION: Our results with this group of patients
after interval-treatment or single-shot application of intratympanic
gentamicin demonstrate the effectiveness of this treatment modality
with very low side effects, and, although our experience is still
limited, it allows for expanding the indication on early cases
of Meniere's disease before permanent hearing loss occurs. Even
cases of bilateral Meniere's disease can be treated successfully
using this method. Cochleotoxic side effects can be prevented
by treatment intervals of 7 days.
-----
Ann Readapt Med Phys. 2003 Dec; 46(9): 607-14.
[Benefit of rotational exercises for patients
with Meniere's syndrome, method used by the ENT department of
St-Luc university clinic]
[Article in French]
Nyabenda A, Briart C, Deggouj N, Gersdorff M.
Service d'otorhinolaryngologie, cliniques universitaires Saint-Luc,
universite catholique de Louvain, 10, avenue Hippocrate, 1200
Bruxelles, Belgique. anyabenda@msn.com
OBJECTIVE: To date, the effectiveness of balanced rehabilitation
for patients with Meniere's syndrome has not been unanimously
acknowledged by all physicians and physiotherapists. The purpose
of this study is to assess the therapeutic efficacy of rotational
exercises in the treatment of disequilibrium for patients with
unilateral Meniere's syndrome. METHODOLOGY: Rotational stimuli
were used to symmetrize and reduce postrotatory nystagmic response.
Three reference sources were used to assess the efficacy of this
management: vestibulospinal function tests: pre- and post-treatment
results at the Romberg test, the Unterberger-Fukuda stepping test,
the Babinski-Weil test, and gait testing with eyes closed; rotational
tests: pre- and post-treatment results; and the self-perceived
impact of vertigo: assessed by the Dizziness Handicap Inventory
(DHI) and a scale based on the guidelines of the Japanese Society
of Equilibrium Research (JSER, 1993). The JSER scale provides
quantitative vertigo evaluation; the DHI reflects the patient's
perceptual evaluation of handicap. RESULTS: Patients required
11 sessions (mean value) to attain subjective improvement. Of
the 23 patients, only seven required optokinetic stimulation (mean
requirement: three sessions). Rotational tests and dynamic tests
of the vestibulospinal function improved. The DHI and JSER results
show that patients' post-rehabilitation perceptual evaluation
significantly improved. CONCLUSION: The objective and subjective
measures of disequilibrium in patients with unilateral Meniere's
syndrome were significantly improved.
-----
Laryngoscope. 2003 Nov; 113(11): 1903-7.
Intratympanic steroids: do they acutely improve
hearing in cases of cochlear hydrops?
Hillman TM, Arriaga MA, Chen DA.
Pittsburgh Ear Associates, Pennsylvania 15212-4746, USA.
OBJECTIVE: To study the acute effects on hearing of intratympanic
dexamethasone in patients with cochlear hydrops. STUDY DESIGN:
Retrospective review. METHODS: Patients who met established criteria
for the diagnosis of Meniere's disease or had a history of fluctuating
hearing loss and met hearing loss criteria for Meniere's disease,
indicating cochlear hydrops, underwent a series of one to three
intratympanic injections of dexamethasone in the affected ear.
Follow-up audiograms were obtained 1 week after each injection
and, in many patients, several months after injection. RESULTS:
Fifty patients met inclusion criteria and were studied. Using
the American Academy of Otolaryngology-Head and Neck Surgery reporting
guidelines, hearing improved acutely in 20 of the 50 patients
(40%), was worse in 2 (4%), and did not change in 28 (56%). For
those who improved, the average decrease in threshold was 14.2
dB. Whether the patient had typical Meniere's disease or cochlear
hydrops did not affect the response to therapy. There were no
significant complications from the injections. CONCLUSIONS: Intratympanic
administration of dexamethasone may acutely affect sensorineural
hearing loss associated with endolymphatic hydrops. A prospective,
controlled study is required.
-----
Lin Chuang Er Bi Yan Hou Ke Za Zhi. 2003 Oct; 17(10): 586-7.
[The investigation of operative treatment of Meniere's
disease]
[Article in Chinese]
Han J, Liu Y, Wang H, Fan Z, Fan Z.
Department of Otolaryngology, Clinical College of Shandong University,
Shandong Province Hospital, Jinan 250021.
OBJECTIVE: To investigate the clinical effect of the operations
in the treatment of Meniere's disease. METHOD: Twenty-one patients
with Meniere's disease were treated by the operation of decompression
of the endolymphatic sac. Nine patients were treated by vestibular
neurectomy via retrosigmoid sinus approach. The follow-up time
was between 3 and 6 years. RESULT: In 21 patients by the operation
of decompression of the endolymphatic sac, vertigo was completely
controlled in 11 cases, substantially controlled in 4, limitedly
controlled in 4 and not controlled in 2. In 9 patients underwent
vestibular neurectomy via retrosigmoid sinus approach, vertigo
was completely controlled. CONCLUSION: Endolymphatic sac surgery
is the first way in the operative treatments of Meniere's disease.
The operation of vestibular neurectomy should be adopted only
in the patients who have failed after the operation of endolymphatic
sac surgery or have lost the working ability substantially.
-----
Otol Neurotol. 2003 Sep; 24(5): 800-6.
Hearing loss after intratympanic gentamicin therapy
for unilateral Meniere's Disease.
Martin E, Perez N.
Department of Otolaryngology, Hospital Casa de Salud, Valencia,
Spain.
OBJECTIVE: This study set out to evaluate the hearing changes
that occur during intratympanic gentamicin therapy and to correlate
them with the long-term effects of the treatment on the control
of vertigo and on hearing. STUDY DESIGN: This was a prospective
study. SETTING: Tertiary medical center. PATIENTS: The 71 patients
included in the study had been diagnosed with unilateral Meniere's
Disease as defined within the 1995 American Academy of Otolaryngology-Head
and Neck Surgery guidelines, and had been refractory to medical
treatment for at least 1 year. INTERVENTION: Intratympanic injections
of gentamicin at a concentration of 27 mg/ml were performed at
weekly intervals until indications of vestibular hypofunction
appeared in the treated ear. If there was a recurrence of the
episodes of vertigo, an additional course of injections was performed.
MAIN OUTCOME MEASURE: The 1995 American Academy of Otolaryngology-Head
and Neck Surgery criteria for reporting the treatment outcome
for Meniere's Disease were used. During the period of gentamicin
instillation, weekly audiograms were obtained. The results of
the treatment were expressed in terms of control of vertigo and
hearing level. RESULTS: Vertigo was controlled by gentamicin instillation
in 83.1% of the 71 patients. Two years after the treatment, hearing
loss as a result of the gentamicin injections was observed in
only 11 (15.5%) patients. The recurrence of spells of vertigo
after having initially achieved complete control was noted in
17 (23.9%) patients. Hearing loss at the end of the treatment
occurred in 32.4% of the patients, but it was transitory so that
3 months after ending the treatment it was 12.7% and after 2 years
it was 15.5%. Those patients in whom no change in their level
of hearing occurred during the treatment needed another course
of injections and presented poorer overall control of vertigo.
CONCLUSIONS: Ending weekly intratympanic injections when clinical
signs of vestibular deafferentation appear results in the control
of vertigo in the majority of patients. The hearing changes detected
during the treatment are transitory and are the only clinical
sign that predicts the response to gentamicin instillation.
-----
Nippon Jibiinkoka Gakkai Kaiho. 2003 Sep; 106(9): 880-3.
[Middle ear overpressure treatment in severe Meniere's
disease]
[Article in Japanese]
Shojaku H, Watanabe Y, Maruyama M, Motoshima H, Junicho M, Yasumura
S.
Department of Otolaryngology, Toyama Medical and Pharmaceutical
University, Toyama.
To evaluate the therapeutic effect of middle ear pressure pulse
on endolymphatic hydrops in humans, Meniett20k was used for 12
months in two severe elderly patients with definite Meniere's
disease. The average number of vertigo occurrences in the 6 months
before treatment and in the 12 months after treatment started
was compared. Numeric values (NV) among patients were calculated
and categorized into an improved group (NV = 1-40). For hearing
function, the pure-tone average (PTA) before and 12 months after
treatment started was compared. PTA was calculated based on the
following equation: PTA = (A + 2XB + C)/4. A, B, and C were thresholds
of the pure-tone audiometory at 0.5, 1.0, and 2.0 kHz. In one
case, hearing function was unchanged, but deteriorated in the
other. Pressure pulse treatment may thus be useful in severe cases
of Meniere's, especially in the elderly, bilateral cases, and
in endolymphatic hydrops in a single hearing ear.
-----
Acta Otolaryngol. 2003 Aug; 123(6): 697-703.
Radical scavengers for Meniere's disease after
failure of conventional therapy: a pilot study.
Takumida M, Anniko M, Ohtani M.
Department of Otolaryngology, Hiroshima University School of Medicine,
Hiroshima, Japan. masati@hiroshima-u.ac.jp
OBJECTIVE: To perform a trial to assess the efficacy of radical
scavengers, i.e. rebamipide, vitamin C and glutathione, for the
treatment of Meniere's disease (MD). MATERIAL AND METHODS: Rebamipide
(300 mg/day), vitamin C (600 mg/day) and/or glutathione (300 mg/day)
were given orally for at least 8 weeks to 25 patients with poorly
controlled MD. RESULTS: Of 22 patients, 21 showed marked improvement
of vertigo; 12/27 ears showed improvement of hearing disorders;
17/27 ears showed improvement of tinnitus; and 18/25 patients
showed improvement of disability. CONCLUSION: This study suggests
that treatment using radical scavengers has the potential to become
an effective new therapy for MD.
-----
Acta Otolaryngol. 2003 May; 123(4): 506-14.
Results of vestibular autorotation testing at
the end of intratympanic gentamicin treatment for
Meniere's disease.
Perez N, Martin E, Garcia-Tapia R.
Department of Otorhinolaryngology, University Hospital and Medical
School, University of Navarra, Pamplona, Spain. nperezfer@unav.es
OBJECTIVE: The vestibular autorotation test (VAT) examines
the ocular response to voluntary horizontal and vertical head
movements at frequencies for which the vestibular system is the
main source for eye stabilization. The purpose of this study was
to analyse the VAT results in patients with disabling Meniere's
disease and to evaluate the change in VAT values once treatment
with intratympanic gentamicin had terminated and clinical signs
of vestibular hypofunction could be observed. MATERIAL AND METHODS:
The 30 study subjects were patients diagnosed with definitive
unilateral Meniere's disease that could not be controlled with
medication. The vestibulo-ocular reflexes of each patient were
evaluated by means of the VAT before the first injection of gentamicin
and after the last injection. RESULTS: The pattern of abnormalities
found in this population conformed to the selection criteria and
the findings reflected a severe disabling process, with major
modifications in the vestibulo-ocular reflex. At the end of treatment
there was a reduction in the peak frequency of head oscillation.
Furthermore, we commonly found that, in the horizontal VAT, gain
and phase were reduced while in the vertical VAT some subjects
registered a normal response. The phase in the horizontal and
vertical VATs was most significantly reduced for oscillation frequencies
of 2-3.7 Hz. CONCLUSION: This study provides further evidence
that effective control of vertigo in patients with Meniere's disease
can be achieved by administering intratympanic gentamicin.
-----
Laryngoscope. 2003 May; 113(5): 815-20.
Long-term hearing outcome in patients receiving
intratympanic gentamicin for Meniere's disease.
Wu IC, Minor LB.
Department of Otolaryngology-Head and Neck Surgery, The Johns
Hopkins University School of Medicine, Baltimore, Maryland 21287,
USA.
OBJECTIVE: To determine the long-term hearing outcome in patients
with intractable vertigo caused by unilateral Meniere's disease
who were treated with intratympanic injection of gentamicin. STUDY
DESIGN: The study was a longitudinal analysis of hearing and control
of vertigo in patients with unilateral Meniere's disease who received
intratympanic gentamicin. METHODS: Pure-tone thresholds and speech
discrimination scores on audiometry were analyzed, along with
the control of vertigo. Criteria described in 1995 by the American
Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) were
used. Patients treated with intratympanic gentamicin had "definite"
Meniere's disease and had intractable vertigo despite optimal
medical therapy, no symptoms suggestive of Meniere's disease in
the contralateral ear, and serviceable hearing in the contralateral
ear. The study analyzed the outcomes of 34 patients for whom follow-up
data were available for periods greater than 24 months after intratympanic
gentamicin. RESULTS: Complete control of vertigo (AAOHNS Class
A) was obtained in 90% of the patients. Profound sensorineural
hearing loss occurred as a result of gentamicin injection in 1
of the 34 patients (3%). When data from all patients were grouped
together, hearing was improved in 5 (15%), unchanged in 23 (68%),
and worse in 6 (17%) patients. This distribution of hearing outcome
is similar to that in patients whose symptoms of Meniere's disease
were managed with medical measures. Recurrent vertigo developed
in 10 patients (29%) at an interval of 4 to 15 months after initially
complete control. Treatment with additional intratympanic injection(s)
of gentamicin did not result in a change in hearing. CONCLUSION:
The risk of hearing loss in patients treated with infrequent intratympanic
injection(s) of gentamicin is low.
-----
Vestn Otorinolaringol. 2003; (3): 4-6.
[Dissection of endolymphatic duct in Meniere's
disease]
[Article in Russian]
Pal'chun VT, Levina IuV.
The authors believe that endolymphatic sac (ES) surgery produces
the highest and most persistent effect in comparison with all
other surgical interventions in Meniere's disease (MD). Conventional
views on the mechanisms underlying a beneficial effect of the
ES surgery are revised and a new surgical technique is proposed.
A positive effect of the operation, according to the authors,
depends not on ES decompression but on the ES break taking place
in separation of the dura mater from the bone skull in the outlet
area of the aqueduct of the vestibule (AV). When the AV is separated
from the sac, a rise in endolymphatic pressure is relieved by
the endolymph pushing through the AV as it is not connected with
the ES. 10 year follow-up has shown that this technique excludes
subsequent endolymphatic hydrops.
-----
Otolaryngol Head Neck Surg. 2003 Apr; 128(4): 550-9.
Endolymphatic sac-vein decompression for intractable
Meniere's disease: long term treatment results.
Ostrowski VB, Kartush JM.
Michigan Ear Institute, Farmington Hills 48334, USA.
OBJECTIVES: We sought to determine the long-term efficacy of
endolymphatic sac-vein decompression surgery on patients with
classic Meniere's disease. STUDY DESIGN AND SETTING: Using the
1995 American Academy of Otolaryngology-Head and Neck Surgery
Committee on Hearing and Equilibrium criteria, starting stage,
functional level, vertigo class, and hearing results were addressed.
We studied 68 patients with classic Meniere's disease from a tertiary,
private otology-neurotology practice. Patient data were gathered
by retrospective chart review, questionnaire, and patient interview.
All patients underwent endolymphatic sac-vein decompression with
an average follow-up period of 55 months. RESULTS: Median functional
level before surgery was level 4, improving to level 2 after surgery.
Eighty-one percent of patients showed improvement in functional
level, 12% remained stable, and 7% declined. Long-term vertigo
control was 47% in class A, 25% in class B, 9% in class C, 3%
in class D, and 16% in class F. Twenty percent of patients were
in hearing stage I Meniere's disease; 31%, stage II; 44%, stage
III; and 5%, stage IV. Eighteen percent of patients showed improvement
in hearing class, 64% were stable, and 18% declined. CONCLUSION:
Endolymphatic sac-vein decompression surgery is a safe, nondestructive
surgical option for Meniere's disease that offers durable control
of vertigo and stabilization of hearing for the majority of symptomatic
patients. SIGNIFICANCE: The beneficial long-term outcome of the
endolymphatic sac-vein decompression supports its continued use
as a first-line treatment option in intractable Meniere's disease.
-----
Clin Otolaryngol. 2003 Apr; 28(2): 133-41.
Intratympanic gentamicin for unilateral Meniere's
disease: results of therapy.
Bottrill I, Wills AD, Mitchell AL.
Department of Otolaryngology Radcliffe Infirmary, Oxford, Cambridge,
UK. kris.dowdeswell@orh.nhs.uk
Patients with Meniere's disease that remains refractory to
conservative treatment have traditionally been subjected to ablative
surgery. The purpose of this prospective study was to evaluate
the use of intratympanic gentamicin in eliminating incapacitating
vertigo, while preserving hearing. Over the past 8 years, 83 patients
have received between 1 and 6 intratympanic injections of gentamicin
in an out-patient setting, with duration of therapy titrated to
individual symptom response and effect on hearing. Using established
AAO-HNS guidelines, we present data on 50 patients who have a
minimum of 2 years follow-up. Control or significant improvement
of definitive Meniere's attacks was achieved in 92% of patients
and hearing preserved or improved in 76%. Only one patient experienced
profound sensorineural hearing loss. We feel this treatment option
should be considered and offered to patients in whom medical treatment
has failed.
-----
Acta Otorhinolaryngol Ital. 2003 Apr; 23(2): 78-87.
Meniere's disease and gentamicin: preliminary
results using the minimum effective dose and
integrated therapy.
Sala T.
Department of Otorhinolaryngology, Hospital of Piove di Sacco,
Piove di Sacco, PD, Italy. t.sala@tin.it
Treatment of Meniere's disease is aimed at restoring a normal
quality of life and preserving residual hearing, in view of the
increasing frequency with which the contralateral ear is affected.
Conventional medical treatment (diuretics + vasoactive drugs)
leads to cure in a large percentage of patients (75-95%). In intractable
cases, transtympanic (intratympanic) aminoglycoside therapy, associated
with various techniques, is becoming widespread as an alternative
to surgery. Progressive reduction of the dose introduced into
the middle ear did not prevent the onset of anacusis in several
patients; the variable, unpredictable permeability of the round
window membrane, the object of fundamental studies in the past,
explains this complication. The Author has used gentamicin transtympanically
in Menierians since 1978, and has treated a total of 105 patients.
He first prescribed transtympanic gentamicin therapy that did
not follow, but was integrated with conventional medical treatment
in 22 intractable Menierians, by instilling the minimum effective
dose, to reduce the risk of hearing impairment. Preliminary results,
related to stage of disease, may be summarised as follows: improvement
in the quality of life, as evaluated by the American Academy of
Ophthalmology & Otolaryngology Committee on Hearing and Equilibrium
questionnaire (14 patients--63.63%--at point 1 and 8-36.36%--at
point 2); disappearance of vertigo in 15 patients (68.18%); a
minor vertigo attack in 3 and two minor attacks in 3 others not
affecting quality of life; persistence of occasional unsteadiness
in one patient. Hearing remained unchanged in 15 patients, improved
slightly in 3 cases and worsened slightly in 2; decreased sensitivity
to high tones was observed in 2 patients at the first insertion
of gentamicin. According to the Author, employing integrated therapy
and using the minimum effective dose of gentamicin, the risk of
damage to the cochlear structures may be reduced, although not
excluded, while restoring a good quality of life, even when repeat
instillation is necessary.
-----
ORL J Otorhinolaryngol Relat Spec. 2003 Mar-Apr; 65(2): 84-90.
Labyrinth anesthesia--a forgotten but practical
treatment option in Meniere's disease.
Adunka O, Moustaklis E, Weber A, May A, von Ilberg C, Gstoettner
W, Kierner AC.
ENT Department, University Clinic Frankfurt am Main, Frankfurt/M.,
Germany. adunka@em.uni-frankfurt.de
The aim of this study was to determine the efficiency of labyrinth
anesthesia - the intratympanic instillation of lidocaine--in the
treatment of Meniere's disease and to recall a forgotten method.
Twenty-four patients (15 male, 9 female), aged from 19.7 to 80.6
years (mean: 47.8 years) with the clinical diagnosis of unilateral
Meniere's disease who underwent labyrinth anesthesia in our department
were included in this retrospective study. After local anesthesia
of the tympanic membrane, a solution of 4% lidocaine and furfuryladenine
(Kinetin) was instilled into the tympanic cavity. Patient records,
a questionnaire and a physical examination were used to evaluate
vertigo control, hearing loss, tinnitus, and quality of life according
to the AAO-HNS criteria before and after surgery. Postoperatively,
87.5% of patients reported at least a noticeable decrease of vestibular
symptoms, 66.7% of these patients were free of attacks for an
average of 26.5 months. Postoperative hearing was the same or
even improved in 87.5% of our patients. Tinnitus was not affected
in any individual. Based on the findings presented herein, we
consider labyrinth anesthesia a practicable and, due to its safety,
highly recommendable therapeutic option for patients suffering
from Meniere's disease. Copyright 2003 S. Karger AG, Basel
-----
Ear Nose Throat J. 2003 Mar; 82(3): 185-7, 191-4.
Changing trends in the surgical treatment of Meniere's
disease: results of a 10-year survey.
Silverstein H, Lewis WB, Jackson LE, Rosenberg SI, Thompson
JH, Hoffmann KK.
Ear Research Foundation, Sarasota, Fla., USA. hsilverstein@aol.com
In order to discern trends in surgical procedures used to treat
Meniere's disease in the United States during the 1990s, we mailed
a questionnaire to 700 members of the American Otological Society
and the American Neurotology Society. These physicians were asked
about the frequency, results, and complications of surgical procedures
for Meniere's disease that they had performed between Jan. 1,
1990, and Dec. 31, 1999. Questionnaires were returned by 137 surgeons
(19.6%). Their responses indicated that the number of vestibular
neurectomies, labyrinthectomies, and endolymphatic sac surgeries
all decreased during 1999. Meanwhile, the use of office-administered
intratympanic gentamicin therapy increased rapidly throughout
the entire 10-year period, and by 1999 it had become the most
frequently used invasive treatment for Meniere's disease. Surgeons
now seem to reserve inpatient procedures for cases where intratympanic
gentamicin fails to control vertigo.
-----
Otol Neurotol. 2003 Mar; 24(2): 294-8.
Gentamicin perfusion vestibular response and hearing
loss.
Light JP, Silverstein H, Jackson LE.
Ear Research Foundation, Florida Ear and Sinus Center, Sarasota,
Florida, USA.
OBJECTIVE: To compare hearing results as a function of vestibular
ablation in the treatment of Meniere's Disease, using gentamicin
perfusion. STUDY DESIGN: A retrospective review of patients with
Meniere's Disease treated by gentamicin perfusion of the inner
ear via the MicroWick device. SETTING: A tertiary otologic referral
center. PATIENTS AND INTERVENTIONS: The charts of patients treated
with gentamicin perfusion via the MicroWick between the years
1998 and 2000 were reviewed. The results for patients with functional
hearing in the affected ear were analyzed and were compared with
the results in patients without functional hearing. MAIN OUTCOME
MEASURES: Audiologic and vestibular test results as well as subjective
symptoms. RESULTS: There were 45 patients who met the inclusion
criteria. The averages for speech discrimination score and pure
tone average before treatment were 92% and 38 dB, and after treatment
were 82% and 47 dB. Patients were divided into two groups: Group
1 (20 patients), less than 75% ice air caloric reduced vestibular
response (RVR); Group 2 (25 patients), those who reached greater
than 75% ice air caloric RVR. There were 8 patients (17.6%) with
persistent vertigo; 7 were from Group 1, and 1 was from Group
2, which was statistically significant (p = 0.007)wwww. The pure
tone average dropped an average of 3 dB for Group 1 and 15 dB
for Group 2. The difference in hearing loss between the two groups
was statistically significant (p = 0.01). CONCLUSION: This study
suggests that there is a correlation between the degree of vestibular
ablation, the control of vertigo, and the risk of hearing loss.
Patients with functional hearing seem to have a similar success
rate for vertigo control, compared with patients who already had
lost functional hearing before treatment. Future investigation
may determine if less than 100% RVR, but greater than 75% RVR,
is an alternative end point with adequate vertigo control and
reduced risk of hearing loss.
-----
Laryngoscope. 2003 Mar; 113(3): 456-64.
Intratympanic gentamicin for intractable Meniere's
disease.
Perez N, Martin E, Garcia-Tapia R.
Department of Otolaryngology, University Hospital and Medical
School, University of Navarra, Pio XII 36, 31008 Pamplona, Navarra,
Spain. nperezfer@unav.es
OBJECTIVE: The study aimed to analyze the results of the intratympanic
injection of gentamicin as a treatment option for patients with
unilateral Meniere's disease who were refractory to medical treatment.
STUDY DESIGN: Prospective study in the setting of a tertiary care
medical center. METHODS: Seventy-one patients with unilateral
Meniere's disease according to 1995 American Academy of Otolaryngology-Head
and Neck Surgery 1995 guidelines who had been unresponsive to
medical therapy for at least 1 year were studied. Intratympanic
injections of a prepared concentration of 27 mg/mL gentamicin
were performed at weekly intervals until the development of symptoms
and signs indicative of vestibular hypofunction in the treated
ear. As the main outcome measure, the 1995 American Academy of
Otolaryngology-Head and Neck Surgery criteria for reporting treatment
outcome in Meniere's disease were used. The results of treatment
were expressed in terms of control of vertigo, disability status
(functional level and degree of overall impairment evaluated by
the Dizziness Handicap Inventory and the University of California
Los Angeles Dizziness Questionnaire), hearing level, and quantitative
measurement of vestibular function. RESULTS: Vertigo was controlled
in 83.1% of the 71 patients. Recurrence of vertigo spells after
initially complete control was noted in 17 patients. In 13 of
these patients, this was cured by another course of intratympanic
injections of gentamicin. Functional level and measures of self-reported
handicap were significantly and promptly lowered after treatment
in the patients who attained control of vertigo. Hearing level
as pure-tone average was unchanged 2 years after treatment, but
hearing loss as a result of gentamicin injections occurred in
23 patients at the end of treatment and in 9 and 11 patients at
3 months and 2 years after the treatment, respectively. Vestibular
function was kept normal or reduced in 49.3% of the patients,
whereas in the rest of the patients vestibular areflexia was observed.
Control of vertigo did not depend on the amount of vestibular
damage. CONCLUSIONS: Ending weekly intratympanic injections when
clinical signs of vestibular deafferentation appear can control
vertigo in the majority of patients, and it is a useful alternative,
together with other surgical options, for the treatment of patients
with Meniere's disease who do not respond to medical treatment.
-----
Auris Nasus Larynx. 2003 Feb; 30(1): 25-8.
Insertion of tympanic ventilation tubes as a treating
modality for patients with Meniere's disease: a short- and long-term
follow-up study in seven cases.
Sugawara K, Kitamura K, Ishida T, Sejima T.
Department of Otolaryngology-Head and Neck Surgery, Jichi Medical
School, Tochigi, Japan
OBJECTIVES: As a treatment for patients with Meniere's disease,
insertion of a ventilating tube in tympanic membrane was carried
out, and the effect of the therapeutic modality was analysed.
METHODS: Seven patients (four males and three females, age ranged
35-62 years) with active Meniere's disease were placed with ventilating
tubes in the affected ear and postoperative change in symptoms,
i.e. incapacitating vertigo and hearing loss were investigated.
Disease severity was scored and evaluated pre- and postoperatively
under the guidelines proposed by the Committee on Hearing and
Equilibrium in the American Academy of Otolaryngology-Head and
Neck Surgery (AAO-HNS, 1985). RESULTS: Of the seven cases, the
number of patients and the degree in controlling vertigo after
the treatment were: at 24 months (short-term) five cases with
substantial, one with limited and one with insignificant control,
then at 42 months (long- term) four cases with substantial, three
with limited control, respectively. The degree of disability in
patients at 24 and 42 months of the treatment was compatible with
the level of vertigo controlling. On the other hand, patients'
hearing level was not affected by the treatment. CONCLUSIONS:
Exact explanation for the effect of ventilating tubes in tympanic
membrane is vague and its therapeutic effect was limited. However,
at least this treatment might represent a short-term effect for
the reduction of persistent vertigo in some patients with Meniere's
disease and so it might become a treatment option because of its
simple and less-invasive procedure.
-----
CNS Drugs. 2003; 17(2): 85-100.
Pharmacological treatment of vertigo.
Hain TC, Uddin M.
Department of Neurology, Northwestern University, Chicago, Illinois
60611, USA. t-hain@northwestern.edu
This review discusses the physiology and pharmacological treatment
of vertigo and related disorders. Classes of medications useful
in the treatment of vertigo include anticholinergics, antihistamines,
benzodiazepines, calcium channel antagonists and dopamine receptor
antagonists. These medications often have multiple actions. They
may modify the intensity of symptoms (e.g. vestibular suppressants)
or they may affect the underlying disease process (e.g. calcium
channel antagonists in the case of vestibular migraine). Most
of these agents, particularly those that are sedating, also have
a potential to modulate the rate of compensation for vestibular
damage. This consideration has become more relevant in recent
years, as vestibular rehabilitation physical therapy is now often
recommended in an attempt to promote compensation. Accordingly,
therapy of vertigo is optimised when the prescriber has detailed
knowledge of the pharmacology of medications being administered
as well as the precise actions being sought. There are four broad
causes of vertigo, for which specific regimens of drug therapy
can be tailored. Otological vertigo includes disorders of the
inner ear such as Meniere's disease, vestibular neuritis, benign
paroxysmal positional vertigo (BPPV) and bilateral vestibular
paresis. In both Meniere's disease and vestibular neuritis, vestibular
suppressants such as anticholinergics and benzodiazepines are
used. In Meniere's disease, salt restriction and diuretics are
used in an attempt to prevent flare-ups. In vestibular neuritis,
only brief use of vestibular suppressants is now recommended.
Drug treatments are not presently recommended for BPPV and bilateral
vestibular paresis, but physical therapy treatment can be very
useful in both. Central vertigo includes entities such as vertigo
associated with migraine and certain strokes. Prophylactic agents
(L-channel calcium channel antagonists, tricyclic antidepressants,
beta-blockers) are the mainstay of treatment for migraine-associated
vertigo. In individuals with stroke or other structural lesions
of the brainstem or cerebellum, an eclectic approach incorporating
trials of vestibular suppressants and physical therapy is recommended.
Psychogenic vertigo occurs in association with disorders such
as panic disorder, anxiety disorder and agoraphobia. Benzodiazepines
are the most useful agents here. Undetermined and ill-defined
causes of vertigo make up a large remainder of diagnoses. An empirical
approach to these patients incorporating trials of medications
of general utility, such as benzodiazepines, as well as trials
of medication withdrawal when appropriate, physical therapy and
psychiatric consultation is suggested.
-----
J Laryngol Otol. 2003 Jan; 117(1): 10-6.
Treatment of Meniere's disease by intratympanic
gentamicin application.
Assimakopoulos D, Patrikakos G.
Department of Otorhinolaryngology, University of Ioannina, Medical
School, Ioannina, 45110, Greece. dassimak@cc.uoi.gr
Meniere's disease is a vestibular disorder characterized by
episodic vertigo, tinnitus, fluctuant hearing loss, and ear fullness,
with vertiginous attacks being the most disabling complaint. The
effectiveness of conservative treatment has been variable, while
surgical techniques provide more permanent relief from vertigo,
but pose possible morbidity and cochlear risk. Intratympanic administration
of gentamicin has been proposed as an alternative for patients
with debilitating Meniere's disease who have failed to respond
to standard medical treatment. The goal of such treatment is to
control vertigo by partially or completely destroying the vestibular
system, while at the same time maintaining hearing. In this review
we present the current medical literature on pathophysiology,
pharmacokinetics, administration methods, dosage, treatment protocols,
and problems related to intratympanic administration of gentamicin
for patients with MD. Intratympanic gentamicin administration
is a simple medical modality for treatment of persistent vertigo
in patients with Meniere's disease. According to recent world
research protocols, we propose the instillation of gentamicin
by transtympanic injection, as a quick, easy, well-tolerated,
ambulatory and cost-effective technique. Drug solution concentrations
should be dependent on the frequency, intensity and duration of
vertigo spells, as well as the degree of existing hearing loss,
thus providing progressive vertigo relief with a low possibility
of secondary deafness.
-----
Otol Neurotol 2002 Nov;23(6):941-8
Factors Influencing Quality of Life in Patients
with Meniere's Disease,
Identified by a Multidimensional Approach.
Soderman AC, Bagger-Sjoback D, Bergenius J, Langius A.
PURPOSE To evaluate self-reported quality of life in Meniere's
disease patients by a multidimensional approach and to identify
predictors of the results.STUDY DESIGN Cross-sectional.SETTING
Tertiary referral hospital centers.PATIENTS One hundred-twelve
patients with Meniere's Disease.MAIN OUTCOME MEASURE Questionnaires
concerning quality of life: Short Form 12 (SF-12) including the
Mental Component Summary (MCS-12) and the Physical Component Summary
(PCS-12), Hospital Anxiety and Depression Scale (HAD), Sickness
Impact Profile (SIP), the Function Level Scale (FLS) from the
American Association of Otology's criteria for reporting results
of treatment of Meniere's Disease, Vertigo Symptom Scale (VSS),
Hearing Disability Handicap scale (HDHS), Tinnitus Severity Questionnaire
(TSQ), and Sense of Coherence (SOC) Scale.RESULTS The Meniere's
patients rated their quality of life significantly worse than
did healthy reference groups in both the physical and the psychosocial
dimensions. The SOC affected the results of the HAD, the MCS-12,
and the psychosocial dimension of the SIP. The VSS affected the
results of PCS-12, both dimensions of the SIP, and the FLS. The
speech perception subscale of the HDHS affected the MCS-12, and
tinnitus severity affected the HAD anxiety subscale. The results
of the FLS correlated with the physical dimension of quality of
life.CONCLUSION The Meniere's patients experienced a worse quality
of life than did healthy subjects. Vertigo mainly influenced the
physical dimension, whereas tinnitus and hearing loss influenced
the psychosocial dimension. Sense of coherence had an impact on
the psychosocial dimension. The FLS was not sensitive enough to
serve as an outcome of treatment results but needed to be complemented
by quality of life instruments.
-----
Otolaryngol Clin North Am 2002 Apr;35(2):287-95, vi
Transtympanic gentamicin perfusion for the
treatment of Meniere's disease.
Schwaber MK.
Nashville EAR Institute, 4230 Harding Rd #803, Nashville, TN
37205, USA.
Meniere's syndrome is defined as the clinical disorder associated
with the histopathological finding of endolymphatic hydrops (ELH).
Clinically, Meniere's syndrome includes the following features:
recurrent, spontaneous episodic vertigo; hearing loss; aural fullness;
and tinnitus. Recognized causes of Meniere's syndrome include:
1) idiopathic, also known as Meniere's disease; 2) posttraumatic,
following head injury or ear surgery; 3) post-infectious or delayed-onset
Meniere's syndrome following a viral infection, usually mumps
or measles; 4) late stage syphilitic; 5) classic Cogan's syndrome
with episodic vertigo, hearing loss, interstitial keratitis, without
syphilis; 6) variant Cogan's syndrome with episodic vertigo, hearing
loss, uveitis or other ocular inflammation and without syphilis.
Although Meniere's disease is by far the most common cause of
Meniere's syndrome and the terms are often used interchangeably,
it should be remembered that a patient has an idiopathic etiology
only when the known causes have been excluded.
--
Laryngol Otol 2002 Aug;116(8):593-6
Posterior fossa vestibular neurotomy as primary
surgical treatment of Meniere's disease: a re-evaluation.
Pareschi R, Destito D, Falco Raucci A, Righini S, Colombo S.
Unita operativa di Otorinolaringoiatria, Azienda Ospedale Legnano,
Universita degli Studi di Padova, Italy. rpareschi@inwind.it
Fifty-eight patients underwent vestibular neurotomy via the
posterior fossa approach between September 1992 and December 1998
at the ENT department of Legnano. All patients presented a history
of disabling unilateral Meniere's disease and underwent complete
neuro-otologic evaluation following the 1985 American Academy
of Otolaryngology-Head and Neck Surgery (AAO-HNS) guidelines.
All patients underwent MRI imaging, ABR and electronystagmographic
testing before surgery. Objective analysis of results is reported
using the criteria published by the Committee on Hearing and Equilibrium
of the AAO-HNS in 1985. According to the AAO formula, 52 patients
obtained a score of 0, indicating complete control of major vertigo
spells, while four were classified within the 'substantial control'
group. Immediate hearing results indicated that 93 per cent of
the patients maintained a level within 10 dB from the pre-operative
level. Only one patient experienced a subtotal hearing loss yet
retained measurable hearing. No major complications were reported.
We conclude that a retrosigmoid approach to vestibular neurotomy
can be considered a safe and effective procedure in relieving
medically refractory vertigo in Meniere's disease while preserving
the hearing. Tinnitus and long-term hearing deterioration are
not influenced by the procedure.
--
Otol Neurotol 2002 Jul;23(4):510-6
Evoked otoacoustic emissions in patients with
Meniere's disease.
de Kleine E, Mateijsen DJ, Wit HP, Albers FW.
Department of Otorhinolaryngology, University Hospital Groningen,
PO Box 30.001, 9700 RB Groningen, The Netherlands.
HYPOTHESIS: This study investigated whether otoacoustic emissions
(OAEs) in patients with Meniere's disease show abnormal properties.
BACKGROUND: Patients with Meniere's disease experience vertigo,
tinnitus, and hearing loss. OAEs are sounds generated in the inner
ear, and their presence is associated with normal hearing. METHODS:
Click-evoked OAEs and distortion product OAEs were measured in
100 patients with Meniere's disease. RESULTS: The incidence of
the emissions in affected ears (56%) was lower than in unaffected
(i.e., contralateral) ears (85%). The mean emission amplitude
in affected ears was also significantly lower (2.6 dB), and the
mean amplitude in unaffected ears was lower than in normal-hearing
ears (5.3 dB). These differences were likely caused by the hearing
loss involved. Further, ears with OAEs clearly showed smaller
hearing losses than ears without OAEs (24-dB difference). The
average hearing loss showed correlations with the emission amplitudes,
although this correlation was not very strong; when plotted against
the smallest hearing loss, a certain upper boundary for the emission
amplitude was present. Also, the amplitude of click-evoked OAEs
showed a considerable correlation with the largest of the three
distortion product OAEs. CONCLUSION: OAEs in patients with Meniere's
disease differed from those in normal-hearing ears but did not
differ from those in non-Meniere's ears with equivalent hearing
loss. This was best observed by comparing emission amplitude with
smallest hearing loss instead of mean hearing loss.
--
Laryngorhinootologie 2002 May;81(5):335-41
[Follow-up assessment of intratympanic gentamicin
therapy and Saccotomia in Meniere's Disease]
[Article in German]
Tauber S, Jager L, Issing WJ.
Klinik und Poliklinik fur Hals-, Nasen- und Ohrenkranke, Ludwig-Maximilians-Universitat
Munchen, Germany.
BACKGROUND: The intratympanic application of ototoxic antibiotics
and saccotomia have been well documented in severe cases of one-sided
Meniere's disease for 30 years now. Both treatment methods are
still subject to controversial discussion. PATIENTS AND MATERIAL:
This study includes 8 patients suffering from persistent one-sided
Meniere's disease after treatment with gentamicin application
and additional saccotomia (n=2). We performed follow-up visits
including the assessment of hearing ability, vestibular function
and cranial MRI, 2-10 years after onset of treatment. RESULTS:
After therapeutic interventions 7 patients reported to be healed
of their symptom vertigo. In 4 patients the gentamicin-treated
vestibular organ did not respond to thermic stimulus at the time
of follow-up examination. Auditory threshold shift was observed
in 3 patients (1 permanent, 2 temporary), whereas hearing threshold
improved in 2 patients. Tinnitus was attenuated in 3 patients,
while 1 patient suffered from posttherapeutic onset of tinnitus.
Morphological and structural changes due to Meniere's disease
and treatment procedures were ruled out by cranial MRI. CONCLUSION:
The intratympanic application of ototoxic medication is a safe
and effective treatment method in severe cases of Meniere's disease.
Saccotomia should be considered as therapeutic regimen for persistent
symptoms after repeated application of gentamicin.
--
J Vestib Res 2002;11(6):405-12
Multivariate vestibular testing: Laterality of
unilateral Meniere's disease.
Dimitri PS, Wall III C, Rauch SD.
Harvard University -- Massachusetts Institute of Technology
Division of Health Sciences and Technology, Boston, USA.
This paper discusses the use of vestibular testing to discriminate
between right (n = 29) and left (n = 27) Meniere's disease. We
examined reduced vestibular response (RVR), directional preponderance,
and spontaneous and positional nystagmus measurements from electronystagmography,
as well as the asymmetry measurements from the sinusoidal harmonic
acceleration test, to determine whether multivariate logistic
regression could improve upon the discrimination performance of
RVR alone. We found that patients with a spontaneous or positional
nystagmus often had a "recovery nystagmus", beating
in the opposite direction of that predicted for an acute lesion.
When present, the direction and magnitude of such nystagmus could
be used in the classification algorithm to increase the discriminatory
power over RVR alone, but in these patients the rotation test
asymmetry measurements were rendered useless. In the absence of
spontaneous or positional nystagmus, asymmetry measurements significantly
enhanced right/left discrimination. Directional preponderance
was insignificant in determining the side of lesion.
--
J Vestib Res 2002;11(6):391-404
Multivariate vestibular testing: Thresholds for
bilateral Meniere's disease and aminoglycoside ototoxicity.
Dimitri PS, Wall III C, Rauch SD.
Harvard University -- Massachusetts Institute of Technology
Division of Health Sciences and Technology, Boston, USA.
Although patient symptoms and an audiogram can typically identify
the affected ear or ears in Meniere's disease, there are some
cases where this differentiation is problematic. This paper concentrates
on the sole use of vestibular test data to discriminate between
unilateral and bilateral Meniere's disease. Patients that were
known to have peripheral unilateral vestibular hypofunction (n
= 104) were used as learning groups to define a region in multidimensional
measurement space consisting of four vestibular test scores which
summarized data from electronystagmography, sinusoidal harmonic
acceleration, and computerized dynamic posturography tests. A
multivariate boundary was created from the unilateral learning
group that determined thresholds for identifying bilateral vestibular
hypofunction. Patients with bilateral Meniere's disease (n = 23)
and with bilateral ototoxicity (n = 19) were then used as test
subjects to determine the sensitivity of the multivariate boundary.
Results showed up to a increase in estimated test sensitivity
(specificity = 95%) from 67%(current method)to 82%(new method)in
identifying bilateral vestibular hypofunction.
--
Acta Otorhinolaryngol Ital 2002 Aug;22(4):199-207
[Intratympanic gentamycin in association with
human fibrin glue in the treatment of
Meniere's disease: preliminary results]
[Article in Italian]
Casani AP, Dallan I, Sellari-Franceschini S, Nuti D.
Dipartimento di Neuroscienze, Sez. ORL, Universita di Pisa.
mailto:acasani@leonet.it
The treatment of Meniere's disease (Md) with intratympanic
gentamicin has rapidly become one of the most widespread alternatives
to surgery in this disorder. Numerous studies, employing different
protocols, have reported the use of this antibiotic in the treatment
of disabling forms of Md, with success rates in the control of
vestibular symptoms varying from 73 to 100%, associated with a
rate of hearing complications varying from 0 to 75%. We have reported
the results of a preliminary experience carried out in 10 patients
affected by monolateral Md who were managed with ablation treatment
effected with a mixture of gentamicin and human fibrin glue. Upon
follow-up examination after one year, all of the patients presented
a marked reduction in vestibular reflectivity on the side treated.
The vertigo score was zero in all of the patients, showing that
the vertigo symptoms were entirely under control. When patients
were asked to rate their disability, vertigo was assessed as completely
under control in 7 patients and substantially under control in
the remaining 3. None of the patients presented any loss of hearing.
On the basis of this experience, we propose a standardized protocol
which, using an extremely low overall dose of gentamicin, enables
elevated success rates to be obtained with the lowest possible
number of injections, thus minimizing the risks to hearing. Intratympanic
gentamicin associated with a fibrin carrier in Md appears to enable
a standardized dose of the drug to be employed, resulting in a
decided reduction in the number of administrations and in the
overall dose of the drug applied. This makes it possible, with
equal benefits in vertigo control, to significantly minimize any
hearing loss.
--
Nurse Pract 2002 Aug;27(8):11-2, 15, 19-23; quiz 24-5
Stop the spinning: diagnosing and managing vertigo.
Sandhaus S.
Geriatric Programs, Moses Taylor Hospital, Scranton, PA, USA.
Differentiating vertigo from other forms of dizziness presents
a diagnostic challenge. Extensive investigation, however, can
help reveal vertigo's true etiology: life-threatening central
lesions or debilitating, but benign, peripheral causes. Here,
learn to assess vertigo using physical examination, history, and
diagnostic procedures. Also, manage symptoms of common vestibular
disorders, such as benign paroxysmal peripheral vertigo, labyrinthitis,
and Meniere's disease.
--
Acta Otorrinolaringol Esp 2002 May;53(5):326-32
[Intra-tympanic gentamicin in the treatment of
Meniere's disease: preliminary results]
[Article in Spanish]
Marin Garrido C, Fraile Rodrigo J, Naya Galvez MJ, Samperiz
LC, Hernandez Montero E, Ortiz Garcia A.
Hospital Universitario Miguel Servet de Zaragoza. crismaring@yahoo.com
In the majority of patients suffering of Meniere's disease,
medical treatment is sufficient to control symptoms, albeit, in
a small number of them, the high intensity and frequency of vertigo
spells makes necessary to adopt more aggressive measures, like
intratympanic or general aminoglycoside administration, as well
as surgical procedures. We present a prospective and longitudinal
descriptive study with the results of intratympanic gentamycin
in 24 patients labeled of Meniere's disease in the Otolaryngology
Department of "Miguel Servet Hospital" in the last two
years, after a follow-up period of more than a year, during which
controlled medical treatment had been proved unsuccesfull. We
go over the efficacy in terms of frequency of vertigo crisis,
audition average, logoaudiometry and functional level. We obtained
good results over vertigo control (types A and B of the objective
criteria based in the improvement index after treatment) in 16
out of the 24 patients (66.6%), (13 were type A with total absence
of crisis and 3 were type B) and an acceptable result (type C)
in three of them (12.5.%). In the other five patients (20.83%)
results were disappointing (types D and E) compelling to apply
surgical treatment. We have tried to evaluate intratympanic gentamycin
as an alternative treatment to more aggressive technics and we
consider it to be a good option, with a low risk and scarce complications
in the no pharmacologically controlled Meniere's disease patients.
--
Laryngoscope 2002 Aug;112(8 Pt 1):1489-93
Intermittent pressure therapy of intractable Meniere's
disease using the Meniett device:
a preliminary report.
Gates GA, Green JD Jr.
Department of Otolaryngology-Head and Neck Surgery, University
of Washington School of Medicine, Seattle, Washington 98195-7923,
USA. ggates@u.washington.edu
HYPOTHESIS: Treatment with the Meniett device, which applies
intermittent micropressure pulses to the inner ear through a tympanostomy
tube, is effective in controlling vertigo in people with intractable
Meniere's disease. STUDY DESIGN: Short-term, preliminary descriptive
report. METHODS: Ten patients with intractable vertigo despite
adequate medical therapy elected to use the Meniett device. After
placement of a standard tympanostomy tube, the patient self-administers
the Meniett device three times daily. RESULTS: The follow-up ranged
from 3 to 11 months with an average of 8 months. All 10 patients
responded to the therapy with vertigo control in 9 of 10 and a
50% reduction in the 10th case. There was a mean hearing gain
of 6 dB, which was statistically significant. There were no major
complications. Two subjects required tube reinsertion during the
8 months of follow-up. CONCLUSIONS: Use of the Meniett device
is an effective and safe option for people with intractable vertigo
from Meniere's disease.
--
Otol Neurotol 2002 Jul;23(4):517-20; discussion 520-1
Immunologic and serologic testing in patients
with Meniere's disease.
Ruckenstein MJ, Prasthoffer A, Bigelow DC, Von Feldt JM, Kolasinski
SL.
Department of Otorhinolaryngology-Head and Neck Surgery and
Division of Rheumatology, University of Pennsylvania, 3400 Spruce
Street, 5 Ravdin, Philadelphia, PA 19104, U.S.A. michael.ruckenstein@uphs.upenn.edu
OBJECTIVE: To establish the value of immunologic and serologic
testing in patients with Meniere's disease. STUDY DESIGN: Prospective
cohort. SETTING: University-based, tertiary care balance center.
INTERVENTION: Patients with active unilateral or bilateral Meniere's
disease underwent testing, including antinuclear antibodies, anti-DNA
antibodies, rheumatoid factor, complement levels, anti-Sjogren
syndrome A and B antibodies, sedimentation rate, antiphospholipid
antibodies, Western blot for anticochlear antibodies (anti-heat
shock protein 70), microhemagglutination test for Treponema pallidum,
and Lyme titers. OUTCOME MEASURES: Results of laboratory tests.
RESULTS: In patients with unilateral Meniere's disease (n = 40),
27% demonstrated elevated antiphospholipid antibody titers (population
norm, 6-9%). The majority of these patients manifested negative
assays on the other tests listed above. In patients with bilateral
Meniere's disease (n = 18), elevations in antinuclear antibody
titers (38%) were the most notable finding. As part of a broader
study of patients with progressive hearing loss, four patients
with positive syphilis titers were identified; however, none of
these patients complained of vertigo. CONCLUSION: In general,
the results of this study do not support the hypothesis that immune
or infectious pathologies are involved in the pathogenesis of
unilateral Meniere's disease. In particular, Lyme disease does
not seem to cause labyrinthine disease. However, the potential
role of the thrombogenic antiphospholipid antibodies must be further
investigated. Patients with bilateral Meniere's disease may be
more likely to have a systemic autoimmune process.
--
Otol Neurotol 2002 Jul;23(4):494-502; discussion 502-3
Efficacy of increased gentamicin concentration
for intratympanic injection therapy in Meniere's disease.
Abou-Halawa AS, Poe DS.
Faculty of Medicine, Suez Canal University, Ismailia, Egypt.
OBJECTIVES: Update of ongoing case series of intratympanic
gentamicin use in intractable Meniere's disease. Comparison of
the treatment results of two gentamicin concentrations: 30 mg/ml
and 40 mg/ml. STUDY DESIGN: Retrospective case-matched review
of an ongoing protocol. SETTING: Ambulatory visits in an office
setting. PATIENTS: Eighty-seven patients were included in this
study according to the 1995 guidelines of the American Academy
of Otolaryngology-Head and Neck Surgery (AAO-HNS) for reporting
treatment results of Meniere's disease. INTERVENTION: Intratympanic
injection of a buffered gentamicin solution (30 mg/ml) was used
in 44 patients (Group 1) in years 1992 to 1995. Stock gentamicin
solution (40 mg/ml) was used in 43 patients (Group 2) in years
1996 to 1999. Treatment was titrated for each patient, and the
hearing was strictly monitored. The endpoint of treatment was
the complete cessation of vertigo spells. MAIN OUTCOME MEASURES:
Hearing results, vertigo control scores, and ice water caloric
testing responses were analyzed after 24 months of follow-up.
Thirty-two patients from each group were selected for case-matched
statistical analysis. RESULTS: Four or fewer gentamicin injections
were used in 70% of Group 1 patients and 96% of Group 2 patients.
In Group 1, vertigo control was achieved in 81% of patients, and
the hearing remained the same or was improved in 68% of patients.
In Group 2, vertigo control was achieved in 72% of patients, and
the hearing remained the same or was improved in 81% of patients.
Treatment was aborted in four patients of Group 2 for early reversible
hearing loss, and 31 of 39 patients (79%) who completed the protocol
experienced lasting vertigo control. There was a trend for longer-lasting
vertigo control in the Group 2 patients. CONCLUSION: It was concluded
that increasing the gentamicin concentration to 40 mg/ml probably
produces similar rates of vertigo control as those of the lower
dose, at least initially, but requires fewer injections. The higher
dose did not increase the risk of hearing loss if treatment was
stopped at the first indication of injury. A larger study is needed
to confirm the trend of improved long-term hearing results in
patients treated with the 40 mg/ml solution.
--
Laryngoscope 2002 Jun;112(6):1104-9
Benign paroxysmal positional vertigo in patients
with Meniere's disease treated with
intratympanic gentamycin.
Perez N, Martin E, Zubieta JL, Romero MD, Garcia-Tapia R.
Department of Otolaryngology, University Hospital and Medical
School, University of Navarra, Spain. nperezfer@unav.es
OBJECTIVES: To analyze the incidence and characteristics of
benign paroxysmal positional vertigo (BPPV) in patients with Meniere's
disease who did not respond to medical treatment and to whom intratympanic
gentamycin treatment was proposed. STUDY DESIGN: This is a retrospective
analysis of the patients in our database. A complete otoneurologic
bedside examination of each patient, including assessment of positional
nystagmus, was performed at the time of diagnosis and during the
follow-up. RESULTS: Nine of 90 patients with Meniere's disease
also had BPPV, which manifested in different ways. In 3 patients,
BPPV preceded the onset of Meniere's symptomatology in the same
ear; in 1, BPPV manifested after treatment for Meniere's disease
had ended and the patient was in complete control of the spontaneous
spells of vertigo; in 5 cases, recurrences of both Meniere's disease
and the positioning symptomatology coincided. Treatment for each
condition was conducted independently and favorable results were
obtained after long-term follow-up when Meniere's disease and
BPPV did not coincide simultaneously. In the group manifesting
symptoms of both disorders at the same time, gentamycin treatment
with the Canalith Repositioning Procedure and/or Semont maneuver
partially resolved the symptoms. CONCLUSIONS: In the context of
Meniere's disease, the sequence of appearance of BPPV relative
to the spontaneous episodes must be taken into account when planning
the treatment for each of the disorders, which should be considered
independently. This pattern could also influence the prognosis
for each disorder.
--
Laryngoscope 2002 Apr;112(4):689-95
Intentional ablation of vestibular function using
commercially available topical gentamicin-betamethasone eardrops
in patients with Meniere's disease: further evidence for topical
eardrop ototoxicity.
Kaplan DM, Hehar SS, Bance ML, Rutka JA.
Department of Otolaryngology, University Health Network, Toronto
General Hospital, University of Toronto, Ontario, Canada.
OBJECTIVE: To determine whether the controversial findings
of suspected ototoxicity from commercially available gentamicin
sulfate and betamethasone sodium phosphate eardrops can be used
in a therapeutic fashion to ablate (or attenuate) vestibular function
in patients with unilateral Meniere's disease. STUDY DESIGN: Prospective
case review. METHODS: At a tertiary care dizziness unit at the
University Health Network, Toronto General Hospital, University
of Toronto (Toronto, Ontario, Canada), adults with unilateral
Meniere's disease undergoing intratympanic ablation therapy were
studied. After insertion of a tympanostomy tube with the patient
under local anesthesia, patients instilled gentamicin containing
eardrops three times daily until they became vertiginous for longer
than 24 hours and then for an additional 2 days longer or for
1 month, whichever came first. Electronystagmographic caloric
test responses were measured before treatment using bithermal
water caloric and after treatment using air caloric tests. Main
outcome measures included clinical titration of drops to the onset
of prolonged vertigo. As well, post-treatment findings on electronystagmography
and audiometry were compared with pretreatment testing. RESULTS:
Twenty patients were available for review. Fifteen patients had
a significant reduction in caloric test responses compared with
pretreatment values; among them, 10 patients had absent air caloric
test responses on the treated side. In 10 patients hearing worsened
according to the 1995 American Academy of Otolaryngology-Head
and Neck Surgery Committee on Hearing and Equilibrium Guidelines
for reporting in Meniere's disease. CONCLUSIONS: Topical gentamicin-betamethasone
eardrops can pass through a tube into the middle ear, where they
may prove primarily vestibulo-ototoxic patients with Meniere's
disease. The study further confirms clinical observations that
gentamicin-containing eardrops might prove ototoxic, especially
in noninflamed ears with a tympanic membrane defect.
--
Ann Otol Rhinol Laryngol 2002 Jul;111(7 Pt 1):653-6
Perilymphatic pressure measurement in Meniere's
disease.
Ayache D, Plouin-Gaudon I, Bouzerar K, Elbaz P.
Department of Otorhinolaryngology, Fondation Adolphe de Rothschild,
Paris, France.
The aim of this study was to evaluate the perilymphatic pressure,
by means of the MMS-10 Tympanic Displacement Analyzer (TDA), in
patients with Meniere's disease (MD). Measurements were performed
in 37 patients with MD and in 14 normal-hearing subjects. Data
were collected from 3 groups: healthy ears of normal-hearing subjects,
unaffected ears of patients with MD, and affected ears of patients
with MD. Analysis of the results obtained with the TDA showed
no significant differences between the 3 groups. Several hypotheses
could explain this lack of difference: 1) perhaps indirect measurement
of perilymphatic pressure with the TDA is not relevant; 2) perhaps
hyperpressure of the inner ear is not the physiological basis
for the clinical triad of MD; or 3) perhaps endolymphatic hydrops
does not produce changes in perilymphatic pressure. The results
of this series indicate that the TDA is not useful in the evaluation
of patients with MD.
--
Eur Arch Otorhinolaryngol 2002 May;259(5):239-42
Revision surgery after saccotomy for Meniere's
disease: does it make sense?
Schwager K, Baier G, El-Din N, Shehata-Dieler W, Carducci F,
Helms J.
Department of Otolaryngology, Head and Neck Surgery, University
of Wurzburg, Josef-Schneider-Str. 11, Germany. k.schwager@mail.uni-wuerzburg.de
Saccotomy is an established surgical treatment for Meniere's
disease that involves exposing and opening the endolymphatic sac
and draining the endolymph. However, in patients experiencing
recurrent vertigo after saccotomy, it is questionable whether
revision saccotomy should be recommended as opposed to more invasive
procedures, such as neurectomy of the vestibular nerve. To determine
the utility of revision saccotomy, we conducted a retrospective
study of 29 patients undergoing this procedure for recurrent vertigo.
Patient charts were reviewed for the re-occurrence of any vertiginous
symptoms and outcomes with regard to hearing results and post-operative
complications. An attempt was made to correlate vertigo status
post-revision with surgical findings at the time of revision.
After an average follow-up of 20 months, 18 patients (62%) were
free of vertigo, and four patients (14%) had a significant decrease
in the frequency and intensity of vertiginous attacks. Two patients
(7%) relapsed after a vertigo-free period of 18 months, and five
patients (17%) experienced no clinical improvement after revision
surgery. In patients with a successful sac revision, a common
finding at the time of revision was new bone formation in the
endolymphatic sac area (n=11), which may have caused blocking
of the endolymphatic drainage. Our results demonstrate that revision
saccotomy should be considered for recurrent Meniere disease before
other, more invasive, surgical options.
--
ORL J Otorhinolaryngol Relat Spec 2002 Mar-Apr;64(2):125-8
A case against spiral ligament atrophy as a cause
of Meniere's disease.
Harris JP, Keithley EM.
Division of Otolaryngology-Head and Neck Surgery, University
of California and Research Service of the Department of Veterans
Affairs, San Diego 92103-8895, USA. jpharris@ucsd.edu
The etiology of Meniere's disease and endolymphatic hydrops
has been very difficult to determine. In order to develop rational
therapies for patients with Meniere's disease the etiology needs
to be established. In the current study an examination was made
of the spiral ligament in temporal bones from individuals with
Meniere's and endolymphatic hydrops and normal control temporal
bones. No evidence of atrophy in either the length or width or
the fibrocyte cell density was seen in the temporal bones with
Meniere's disease. The role of the spiral ligament in the development
of endolymphatic hydrops is still unclear. Copyright 2002 S. Karger
AG, Basel
--
Int J Pediatr Otorhinolaryngol 2002 May 31;64(1):61-4
Vestibular nerve section in a child with intractable
Meniere's disease.
See GB, Mahmud MR, Zurin AA, Putra SH, Saim LB.
Department of Otorhinolaryngology, Medical Faculty, Universiti
Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, 56000
Cheras, Kuala Lumpur, Malaysia. irenegbs@hotmail.com
Clinical presentation of Meniere's disease in children is not
as typical as in adults. The triad of vertigo, tinnitus and deafness
are not usually elicited, diagnosis often being made after years
of follow up and batteries of investigation. A case of Meniere's
disease in a 3-year-old boy is presented. The diagnosis was only
obvious at the age of 8 when the triad of vertigo, deafness and
tinnitus were present. His disease progressed despite a trial
of intratympanic gentamicin injections and endolymphatic sac decompression.
Vestibular nerve section was subsequently performed for his intractable
disease. Following the procedure he was asymptomatic and able
to attend school.
--
J Otolaryngol 2002 Apr;31(2):106-11
Hearing loss following intratympanic instillation
of gentamicin for the treatment of
unilateral Meniere's disease.
Kaplan DM, Nedzelski JM, Al-Abidi A, Chen JM, Shipp DB.
Department of Otolaryngology, Sunnybrook and Women's College
Health Science Centre and the University of Toronto, Ontario.
OBJECTIVE: To determine the incidence, extent, and time course
of hearing loss following instillation of intratympanic gentamicin
using a predetermined fixed protocol for incapacitating unilateral
Meniere's disease and to determine whether such loss is associated
with any identifiable risk factors. STUDY DESIGN: A retrospective
analysis of all patients treated with intratympanic gentamicin
between 1988 and 1998 using American Academy of Otolaryngology-Head
and Neck Surgery reporting guidelines (1985 and 1995). A predetermined
regimen using a fixed dose (gentamicin 26.7 mg/mL administered
three times daily for 4 consecutive days) was used. METHODS: The
records of patients treated with this particular protocol were
reviewed. The relationship between pretreatment hearing acuity,
pretreatment bithermal caloric response, duration of symptoms,
and previous treatment to post-treatment hearing were analyzed
with respect to hearing. RESULTS: Complete vestibular and audiologic
data over a minimum 2-year follow-up were available for 85 individuals.
Sixty-three patients (74.1%) had unchanged or improved hearing,
and 22 patients (25.9%) realized hearing loss. In 80% of the latter,
it occurred during the first month post-treatment. When hearing
acuity at the 1-month post-treatment interval remained unchanged
(91.1%), it was likely to remain so over the next 23 months. A
significantly higher incidence of profound hearing loss was noted
in patients who developed hearing loss in the first month, as
compared with those who developed hearing loss at a later period
(p = .0207, relative risk = 1.5). Re-treatment was not associated
with hearing loss. The only identifiable risk factor for developing
hearing loss was pretreatment hearing acuity stages 3 and 4 (pure-tone
average > 40 dB) (p = .022, relative risk = 1.5). CONCLUSION:
Hearing loss is a recognized complication of treatment with intratympanic
gentamicin, occurring in approximately 26% of individuals. In
those individuals in whom hearing acuity has remained unchanged
after the first month interval, significant worsening of hearing
is unlikely, and patients can be reassured accordingly.
--
Otolaryngol Head Neck Surg 2002 Mar;126(3):244-56
Continuous gentamicin therapy using an IntraEAR
microcatheter for Meniere's disease:
a retrospective study.
Seidman M.
Department of Otolaryngology-Head and Neck Surgery, Henry Ford
Health System, West Bloomfield, Michigan 48322, USA. mseidma1@hfhs.org
OBJECTIVES: The study goals were to evaluate the safety and
effectiveness of continuous gentamicin therapy (CGT) in the treatment
of Meniere's disease and to evaluate the effect of flow rate.
STUDY DESIGN: In a retrospective study, physicians who were known
to have used CGT in the treatment of Meniere's disease were asked
to report patient information on a standardized data collection
form. RESULTS: In patients treated with low-flow CGT, vertigo
was eliminated or substantially controlled in 90%, tinnitus was
improved in 69%, pressure was improved in 77%, hearing was worse
in 23%, and vestibular function was ablated in only 14% of patients.
CONCLUSION: On the basis of an average 10-month follow-up period,
of the methods currently available to treat Meniere's patients
with gentamicin, low-flow CGT seems to provide an excellent combination
of vertigo control and tinnitus and pressure improvement, with
a relatively low risk to hearing and vestibular function. SIGNIFICANCE:
The clinical use of low-flow CGT appears to be justified based
on these data.
--
Vojnosanit Pregl 2002 Jan-Feb;59(1):11-5
[New possibilities in the treatment of Meniere's
disease]
[Article in Serbo-Croatian (Cyrillic)]
Milanovic N, Kitanoski B, Ristic B, Jacimovic V.
The results of the treatment of Meniere's disease by intratympanic
instillation of gentamicin in 32 patients over a 24-months period
were analyzed. The receded vestibular function was found in 96.8%
patients, whereas in the remaining 3.2% pronounced vestibular
hypofunction was observed. One month after the treatment vertiginous
attacks disappeared in all the patients. However, three months
after the treatment infrequent episodes of mild degree vertigo
and mild unsteadiness that did not require additional intratympanic
gentamicin application appeared in 15% of the patients with Meniere's
disease. The vertiginous attacks ceased or were pronouncedly reduced
in 85% of the patients. The unstable vestibular hypofunction was
successfully converted into stabilized, centrally compensated
areflexia. Intratympanic gentamicin exerted better results than
the other invasive therapies for intractable Meniere's disease.
--
Ann Otol Rhinol Laryngol 2002 Mar;111(3 Pt 1):237-45
Vascular occlusion in the endolymphatic sac in
Meniere's disease.
Friberg U, Rask-Andersen H.
Department of Otorhinolaryngology-Head and Neck Surgery, Uppsala
University Hospital, Sweden.
In 2 patients with severe Meniere's disease (MD), there was
histologic evidence of occlusion of the vein of the vestibular
aqueduct (VVA). This finding coincided with total or partial occlusion
of numerous small vessels around the endolymphatic sac (ES), flattening
of epithelium, extensive perisaccular fibrosis, and signs of new
bone formation. Ultrastructural analysis of the occluding material
showed foci with dense connective tissue, calcification, lipid
deposits, and layers of basement membrane, sometimes concentrically
arranged. The exact nature of the occluding material was unknown.
In another 2 MD patients, the VVA was not visualized, and the
ES vessels showed no signs of occlusion. Seven controls with acoustic
schwannoma or meningioma had normal vasculature. The presence
of vascular impairment in the ES in MD patients indicated that
altered hemodynamics may contribute to the pathogenesis of endolymphatic
hydrops and MD.
--
Auris Nasus Larynx 2002 Apr;29(2):115-9
Hearing loss and tinnitus in Meniere's disease.
Havia M, Kentala E, Pyykko I.
Department of Otolaryngology, Helsinki University Hospital,
PB 220, 00029 Hus, Helsinki, Finland. mari.havia@kolumbus.fi
OBJECTIVES: To characterize hearing loss, tinnitus and associative
factors in Meniere's disease. METHODS: From our vertigo database
consisting of 1356 patients, we retrieved 243 patients with Meniere's
disease (MD). RESULTS: Hearing loss was the initial symptom in
13% of cases. Altogether 64% (n=133) of the patients stated that
their hearing was reduced during the vertigo attack. The hearing
deteriorated more likely during the vertigo attack if the vertigo
attack was very intense [r(206)=0.19]. Tinnitus was the initial
symptom in 5% of cases. The tinnitus was mild in 38% (n=90), moderate
in 32% (n=76) and severe in 30% (n=72) of patients. The intensity
of tinnitus correlated with the occurrence of drop attacks [r(237)=0.29],
vertigo provoked by head positioning [r(235)=0.25], by physical
activity [r(230)=0.33], or by pressure changes [r(239)=0.27].
CONCLUSION: Prolonged disease causes deterioration of hearing.
Intense tinnitus is common in MD and is more often seen in late
stage of the disease.
--
J Otolaryngol 2002 Feb;31(1):1-4
Genetic basis of familial Meniere's disease.
Fung K, Xie Y, Hall SF, Lillicrap DP, Taylor SA.
Department of Otolaryngology, London Health Sciences Centre,
University of Western Ontario, London.
The genetic basis of familial Meniere's disease (MD) is unclear.
We present a genetic investigation of six individuals in two families
with familial MD. Linkage analysis was performed using polymorphic
DNA markers linked to the human leukocyte antigen (HLA) locus
that map to chromosome 6p. We have demonstrated the presence of
anticipation in successive generations and the absence of HLA
association. This is the second report of anticipation in familial
MD in the literature, and it suggests that efforts should be directed
toward finding a trinucleotide expansion as a possible genetic
lesion in this uncommon disorder.
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