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A Journal on Otorhinolaryngology, Head and Neck Surgery,
Plastic Reconstructive Surgery, Otoneurosurgery
Indexed/Abstracted in: EMBASE, Scopus
Otorinolaringologia 2004 September;54(3):143-7
Pharmacological transtympanic treatment in Menière’s disease. Results of therapy
Mullace M., Gorini E., Sbrocca M., Artesi L., Mevio E.
U. O. di Otorinolaringoiatria Azienda Ospedaliera di Legnano Ospedale «G. Fornaroli», Magenta (Milano)
Aim. Menière’s disease is recalcitrant to medical treatment and in the past has been treated exclusively with surgery aimed at the destruction or deafferentation of the diseased labyrinth. The use of such techniques, however, presents disadvantages such as cophosis, in the case of labyrinthectomy, or the possible complications related to invasive operations such as neurectomy. The use of aminoglycosidic antibiotics in order to provoke chemical labyrinthectomy was proposed in the 50s and was first used clinically in the 60s. The choice of the most reliable molecules and the most correct administration techniques has occupied the attention of otoneurologists in recent years. Whereas substantial agreement has by now been reached regarding the choice of gentamicin sulphate as the most suitable drug for the treatment on account of its lower ototoxicity, there continue to exist disagreements among authors as regards administration methodology.
Methods. Between 2000 and 2002 we treated 23 patients (14 female, 9 male) aged between 23 and 78 (average 46.4) suffering from invalidating Menière’s disease recalcitrant to medical treatment. Two ml gentamicin sulphate was administered to all patients, associated with a buffer solution of 1 ml bicarbonate by injection, in otomicroscopy, at the level of the posteroinferior quadrant of the tympanic membrane (3 sessions with an interval of 7 days). The treatment protocol included the performance of a tonal audiometric examination before and after treatment, with calculation of differences in PTA, the administration before and after of a subjective clinical evaluation questionnaire, impedentiometry, evoked auditory potentials, vestibular examination with heat stimulation (follow-up at 3, 6 and 12 months).
Results. In all controls 3 months from the end of treatment we were able to show the effectiveness of the treatment in a high percentage of cases (22 of 23 patients) with complete remission of the vertiginous symptomatology.
Conclusion. Treatment with transtympanic gentamicin proved extremely effective, practical and reliable for the management of vertiginous symptomatology. If performed with due methodological precautions, deferring administrations, the technique has only slight side-effects.