Transtympanic Gentamicin and Fibrin Tissue Adhesive for Treatment of Unilateral Menière's Disease: Effects on Vestibular Function

2005 ◽  
Vol 133 (6) ◽  
pp. 929-935 ◽  
Author(s):  
Augusto Casani ◽  
Daniele Nuti ◽  
Stefano Sellari Franceschini ◽  
Elisa Gaudini ◽  
Iacopo Dallan
Keyword(s):  
Vestibular Function ◽  
Meniere’S Disease ◽  
Menière’S Disease ◽  
Tissue Adhesive ◽  
Spontaneous Nystagmus ◽  
Meniere's Disease ◽  
Ménière’S Disease ◽  
Menière's Disease ◽  
Vestibular Hypofunction ◽  
Ménière's Disease

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 Menière'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 Menière'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 Menière'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. EBM RATING: C

Vestibular function at the end of intratympanic gentamicin treatment of patients with Ménière's disease

2005 ◽  
Vol 15 (1) ◽  
pp. 49-58
Author(s):  
Nicolas Perez ◽  
Julio Rama-Lopez
Keyword(s):  
Time Constant ◽  
Vestibular Function ◽  
Meniere’S Disease ◽  
Menière’S Disease ◽  
Meniere's Disease ◽  
Ménière’S Disease ◽  
Menière's Disease ◽  
Bedside Examination ◽  
Intratympanic Gentamicin ◽  
Ménière's Disease

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°s-1, and the phase and gain of the VOR after the sinusoidal harmonic acceleration (SHA) test with a peak chair velocity of 50°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.

Drug treatment of vertigo and ménière’s disease cinnarizine and betahistine

1981 ◽  
Vol 19 (5) ◽  
pp. 17-18
Keyword(s):  
Hearing Loss ◽  
Drug Treatment ◽  
Vestibular Function ◽  
Meniere’S Disease ◽  
Menière’S Disease ◽  
Meniere's Disease ◽  
Ménière’S Disease ◽  
Menière's Disease ◽  
Ménière's Disease ◽  
Attacks Of Vertigo

Vertigo and dizziness are major symptoms of disturbed vestibular function. Sudden attacks of vertigo, associated with tinnitus and sensorineural hearing loss, occur in a wide variety of disorders of the inner ear, and when no underlying cause can be found the condition is termed ménière’s disease.

scholarly journals Vibration-induced nystagmus in patients with chronic unilateral Meniere's disease

2021 ◽  
Author(s):  
Elaheh Mosharaf Dehkordi ◽  
Moslem Shaabani ◽  
Ali Kouhi ◽  
Mohsen Vahedi
Keyword(s):  
Vestibular Stimulation ◽  
Meniere’S Disease ◽  
Menière’S Disease ◽  
Spontaneous Nystagmus ◽  
Meniere's Disease ◽  
Ménière’S Disease ◽  
Vibratory Stimulation ◽  
Menière's Disease ◽  
Significant Difference ◽  
Ménière's Disease

Background and Aim: Meniere's disease (MD) is one of the inner ear disorders associated with fluctuating hearing loss, vertigo, ear fullness, and tinnitus. Vestibular stimulation delas with the int­egrity of the peripheral vestibular system and may cause nystagmus due to the functional asy­mmetry between right and lef peripheral vesti­bular system. This study aimed to assess the vibration-induced nystagmus (VIN) in patients with chronic unilateral MD and investigate the effectiveness of this test in detecting the affected ear in these patients. Methods: This study was conducted on 29 pati­ents with chronic unilateral MD. For this pur­pose, spontaneous nystagmus (SN) and VIN at frequencies of 30 Hz and 100 Hz were recorded by videonystagmography test under five recor­ding conditions. The vibratory stimulation was presented to both healthy and affected ears. Coll­ected were analyzed in SPSS v.22 software. Results: Vibratory stimulation compared to the unstimulated condition, revealed a significant difference in eye movements for both healthy and affected ears. Moreover, the difference between VIN and SN in the affected ear was much greater than in the healthy ear. Conclusion: In patients with chronic unilateral MD, 100 Hz vibratory stimulation of the affected ear induces more reliable nystagmus than 30 Hz stimulation and unstimulated condition. The VIN test can be used for the evaluation of the vesti­bular system function and is a promising techni­que to detect the MD ear. Keywords: Meniere's disease; spontaneous nystagmus; vibration-induced nystagmus; chronic; definite; vestibular vibrator

Multivariate vestibular testing: Thresholds for bilateral Ménière's disease and aminoglycoside ototoxicity

2002 ◽  
Vol 11 (6) ◽  
pp. 391-404
Author(s):  
P.S. Dimitri ◽  
C. Wall ◽  
S.D. Rauch
Keyword(s):  
Meniere’S Disease ◽  
Menière’S Disease ◽  
Meniere's Disease ◽  
Ménière’S Disease ◽  
Menière's Disease ◽  
Dynamic Posturography ◽  
Learning Group ◽  
Vestibular Hypofunction ◽  
Ménière's Disease ◽  
Bilateral Vestibular Hypofunction

Although patient symptoms and an audiogram can typically identify the affected ear or ears in Ménière'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 Ménière'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 Ménière'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%) bilateral vestibular hypofunction.

scholarly journals A Puzzle of Vestibular Physiology in a Meniere’s Disease Acute Attack

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Marta Martinez-Lopez ◽  
Raquel Manrique-Huarte ◽  
Nicolas Perez-Fernandez
Keyword(s):  
Acute Attack ◽  
Meniere’S Disease ◽  
Menière’S Disease ◽  
Spontaneous Nystagmus ◽  
Meniere's Disease ◽  
Ménière’S Disease ◽  
Functional Evaluation ◽  
Vestibuloocular Reflex ◽  
Menière's Disease ◽  
Ménière's Disease

The aim of this paper is to present for the first time the functional evaluation of each of the vestibular receptors in the six semicircular canals in a patient diagnosed with Meniere’s disease during an acute attack. A 54-year-old lady was diagnosed with left Meniere’s disease who during her regular clinic review suffers an acute attack of vertigo, with fullness and an increase of tinnitus in her left ear. Spontaneous nystagmus and the results in the video head-impulse test (vHIT) are shown before, during, and after the attack. Nystagmus was initially left beating and a few minutes later an upbeat component was added. No skew deviation was observed. A decrease in the gain of the vestibuloocular reflex (VOR) and the presence of overt saccades were observed when the stimuli were in the plane of the left superior semicircular canal. At the end of the crisis nystagmus decreased and vestibuloocular reflex returned to almost normal. A review of the different possibilities to explain these findings points to a hypothetical utricular damage.

Continuous Gentamicin Therapy Using an IntraEAR Microcatheter for Meniere's Disease: A Retrospective Study

2002 ◽  
Vol 126 (3) ◽  
pp. 244-256 ◽  
Author(s):  
Michael Seidman
Keyword(s):  
Retrospective Study ◽  
Vestibular Function ◽  
Meniere’S Disease ◽  
Menière’S Disease ◽  
Low Flow ◽  
Meniere's Disease ◽  
Ménière’S Disease ◽  
Menière's Disease ◽  
Ménière's Disease ◽  
Gentamicin Therapy

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.

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