Delayed Effect and Gain Restoration After Intratympanic Gentamicin for Menière's Disease

OBJECTIVE:

This study aimed to evaluate the changes in the VOR gain after intratympanic gentamicin therapy and to correlate them with the mid-term effects on the control of vertigo, in a population of Menière's disease patients.

STUDY DESIGN:

The study design was a prospective "Outcomes research."

SETTING:

Tertiary referral center.

PATIENTS:

This study included 20 patients with unilateral Menière's disease refractory to medical therapy for at least 1 year, and treated with an on demand intratympanic gentamicin protocol.

INTERVENTION:

Therapeutic.

MAIN OUTCOME MEASURE:

Audiometry, caloric testing, and a vHIT before beginning the protocol were performed. Patients underwent weekly vHIT assessments until a significant gain reduction was observed. Subsequently we performed vHIT tests 1 month after the therapy completion, and then every 3 months for at least 1 year.

RESULTS:

Complete vertigo control (class A) was achieved in 14 patients at the 12-month follow-up assessment. We observed a significant reduction in VOR gain values at the 3-week follow-up assessment. We found a significant correlation between the 1-month posttreatment ipsilateral hVOR gain and the rate of vertigo recurrence after the first IT gentamicin treatment (p = 0.012; r = 0.400). At the mid-term assessment, 10 patients exhibited a significant partial recovery of the hVOR gain.

CONCLUSIONS:

The delayed effect of intratympanic gentamicin and the subsequent gain restoration are factors that may influence the patients' outcome. The feasibility of the vHIT system makes it a useful tool to monitorize the VOR changes.

CITATION  Otol Neurotol. 2019 Jan;40(1):79-87.  doi: 10.1097/MAO.0000000000001973