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Thangavelu K, Gillhausen F, Weiß RM, Mueller-Mazzotta J, Stuck BA, Reimann K. Role of prior intratympanic gentamicin and corticosteroids therapy on speech understanding in patients with Menière's disease after cochlear implantation. Eur Arch Otorhinolaryngol 2024; 281:3483-3490. [PMID: 38302621 PMCID: PMC11211197 DOI: 10.1007/s00405-024-08449-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 01/02/2024] [Indexed: 02/03/2024]
Abstract
AIM Intratympanic injection of corticosteroids (ITC) and gentamicin therapy (ITG) are widely used treatments for vertigo in Meniere's disease (MD). Even though studies show good results after cochlea implantation (CI) in MD patients when compared to non-MD groups, there is no indication on the effect of ITC and ITG prior to CI on hearing after CI. This study compares the post-operative hearing of CI patients with and without MD and patients who have received ITG or ITC prior to CI. METHODS In a retrospective case control study, adult patients with MD who received CI from 2002 till 2021 were compared to a matched control group of CI patients without MD. Patients with prior ITC/ITG were extracted from MD group. Pre-operative audiological results were measured and trends across post-operative monosyllabic word recognition score at 65 decibels (WRS65CI) at switch-on, 3-6 months, 1 year and last yearly value were analyzed across all groups. RESULTS 28 MD ears were compared with 33 control ears. From MD ears 9 had received ITG and 6 ITC prior to CI. WRS65CI increased significantly with time within MD and control groups, but no difference in WRS65CI was found between these 2 groups. ITG ears showed fluctuating WRS65CI after CI with no change across time, while ITC ears showed significant increase in trend of WRS65CI values across time. CONCLUSION MD and non-MD patients showed comparable hearing results after CI. Prior ITC might positively influence hearing preservation after CI in MD patients whereas ITG group showed fluctuating hearing.
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Affiliation(s)
- Kruthika Thangavelu
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Baldingerstrasse, 35043, Marburg, Germany.
| | - Frederic Gillhausen
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Rainer M Weiß
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Jochen Mueller-Mazzotta
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Boris A Stuck
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Katrin Reimann
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Baldingerstrasse, 35043, Marburg, Germany
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Wegmann-Vicuña R, Manrique-Huarte R, Calavia-Gil D, Martín-Sanz E, Marques P, Perez-Fernandez N. Low-Dose Intratympanic Gentamicin for Unilateral Ménière‘s Disease: Accuracy of Early Vestibulo-Ocular Reflex Gain Reduction in Predicting Long-Term Clinical Outcome. Front Neurol 2022; 13:808570. [PMID: 35370892 PMCID: PMC8973913 DOI: 10.3389/fneur.2022.808570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 01/04/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe number of intratympanic gentamicin (ITG) injections needed to achieve vertigo control in patients with intractable Ménière's disease (MD) may vary from a single dose to several instillations. Changes in different vestibular test results have been used to define an endpoint of treatment, including the decrease of the vestibulo-ocular reflex (VOR) gain elicited by the head-impulse test.ObjectiveTo assess the accuracy of the VOR gain reduction after horizontal canal stimulation, as measured with the video head-impulse test (vHIT) 1 month after the first intratympanic injection, in predicting the need for one or more instillations to control vertigo spells in the long term.MethodsThe VOR gain reduction was calculated in 47 patients submitted to (ITG) therapy 1 month after the first instillation.ResultsSingle intratympanic treatment with gentamicin has a 59.6% efficacy in vertigo control in the long term. Hearing change in the immediate period after treatment (1 month) is not significant to pre-treatment result and is similar for patients who needed multiple doses due to recurrence. Chronic disequilibrium and the need for vestibular rehabilitation were less frequent in patients with a good control of vertigo with just one single injection of gentamicin. A fair accuracy was obtained for the VOR gain reduction of the horizontal canal (area under the curve = 0.729 in the Receiver Operating Characteristic analysis) in predicting the need for one or more ITG.ConclusionsSingle intratympanic treatment with gentamicin is an effective treatment for patients with MD. That modality of treatment has very limited damaging effect in hearing. The degree of vestibular deficit induced by the treatment is significant as measured by the reduction in the gain of the VOR but not useful for prognostic purposes.
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Affiliation(s)
- Ricardo Wegmann-Vicuña
- Department of Otorhinolaryngology, Clínica Universidad de Navarra, Pamplona, Spain
- Department of Otorhinolaryngology, Hospital Quirónsalud, Barcelona, Spain
| | | | - Diego Calavia-Gil
- Department of Otorhinolaryngology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Eduardo Martín-Sanz
- Department of Otolaryngology, University Hospital of Getafe, Madrid, Spain
- Department of Medicine, School of Biomedical Sciences and Health, Universidad Europea de Madrid, Madrid, Spain
| | - Pedro Marques
- Department of Otorhinolaryngology, S. João Hospital Centre, Porto, Portugal
| | - Nicolas Perez-Fernandez
- Department of Otorhinolaryngology, Clínica Universidad de Navarra, Pamplona, Spain
- Department of Otorhinolaryngology, Clínica Universidad de Navarra, Madrid, Spain
- *Correspondence: Nicolas Perez-Fernandez
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Abstract
The number of older people has been increasing over recent decades in Western populations. Dizziness, imbalance, and vertigo constitute some of the most common complaints in older patients, and risk of falling is the most frequent and worrying consequence. It has been reported that 15–20% of the adult population experiences these debilitating symptoms. Among the diseases that may be associated with vertigo, the three classes of otological, central, and functional (psychological) dizziness may be distinguished. Overall, vestibular disorders account for 48% of vertiginous complaints in the older population. The main focus of this article is to review the forms of pharmacotherapy for vertigo, especially with regard to older patients, who may be treated simultaneously with other drugs for different comorbidities. Interactions with other drugs should be considered in the choice of a particular course of treatment. Moreover, overuse of pharmacotherapy for the management of vertigo in the elderly may prevent the development of the central compensatory mechanism that sustains both static and dynamic imbalance after a vertiginous crisis. In the majority of patients, vestibular and physical rehabilitation are strongly advised and rarely contraindicated.
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Calic Z, Nham B, Taylor RL, Young AS, Bradshaw AP, McGarvie LM, Colebatch JG, Cordato D, Cappelen-Smith C, Welgampola MS. Vestibular migraine presenting with acute peripheral vestibulopathy: Clinical, oculographic and vestibular test profiles. CEPHALALGIA REPORTS 2020. [DOI: 10.1177/2515816320958175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
To describe clinical, oculographic and vestibular test profiles in patients with vestibular migraine (VM) who presented with acute peripheral vestibulopathy. VM was diagnosed according to Bárány Society or Neuhauser criteria. Neuro-otological examination, video-head impulse tests (v-HIT), cervical and ocular vestibular-evoked myogenic potentials (cVEMP/oVEMP), subjective visual horizontal (SVH) and audiometry were undertaken. Ten patients presented with prolonged vertigo. All had primary position unidirectional horizontal spontaneous nystagmus (mean slow-phase velocity 9.6 ± 7.0°). Horizontal canal vestibulo-ocular reflex was reduced in all (mean gain 0.54 ± 0.2) with refixation saccades (cumulative amplitude 6.4 ± 3.2°). Abnormality rates for cVEMP, oVEMP and SVH were 30%, 80%, 78%, respectively. Magnetic resonance imaging brain was normal in all patients. Patients were followed up over 6 months to 8 years with no change in the final diagnosis. VM can rarely present as an acute peripheral vestibulopathy with findings that mimic vestibular neuritis and should be considered in the differential diagnosis of acute prolonged vertigo.
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Affiliation(s)
- Zeljka Calic
- Department of Neurophysiology, Liverpool Hospital, Liverpool, NSW, Australia
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Benjamin Nham
- Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Rachael L Taylor
- Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- Department of Physiology and Centre for Brain Research, The University of Auckland, Auckland, New Zealand
| | - Allison S Young
- Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- Central Clinical School, Sydney Medical School, University of Sydney, Camperdown, NSW, Australia
| | - Andrew P Bradshaw
- Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Leigh M McGarvie
- Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - James G Colebatch
- Institute of Neurological Sciences, Prince of Wales Hospital, Randwick, Sydney, NSW, Australia
| | - Dennis Cordato
- Department of Neurophysiology, Liverpool Hospital, Liverpool, NSW, Australia
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Cecilia Cappelen-Smith
- Department of Neurophysiology, Liverpool Hospital, Liverpool, NSW, Australia
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Miriam S Welgampola
- Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- Central Clinical School, Sydney Medical School, University of Sydney, Camperdown, NSW, Australia
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Espinosa-Sanchez JM, Lopez-Escamez JA. The pharmacological management of vertigo in Meniere disease. Expert Opin Pharmacother 2020; 21:1753-1763. [DOI: 10.1080/14656566.2020.1775812] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Juan Manuel Espinosa-Sanchez
- Department of Otolaryngology, Instituto de Investigación Biosanitaria Ibs.GRANADA, Hospital Universitario Virgen de las Nieves, Universidad de Granada, Granada, Spain
- Otology & Neurotology Group CTS 495, Department of Genomic Medicine, GENYO. Centre for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional, Government PTS Granada, Granada, Spain
| | - José A. Lopez-Escamez
- Department of Otolaryngology, Instituto de Investigación Biosanitaria Ibs.GRANADA, Hospital Universitario Virgen de las Nieves, Universidad de Granada, Granada, Spain
- Otology & Neurotology Group CTS 495, Department of Genomic Medicine, GENYO. Centre for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional, Government PTS Granada, Granada, Spain
- Department of Surgery, Division of Otolaryngology, Universidad de Granada, Granada, Spain
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