Skip to main content
SpringerLink
Log in

Vestibular results after intratympanic gentamicin therapy in disabling Menière’s disease

  • Otology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Intratympanic injection of gentamicin is increasingly used in the treatment of unilateral disabling Menière’s disease (MD). Several objective functional and subjective tests have been developed to assess the control of vertigo after gentamicin treatment. The aim of this study was to show that subjective results require a vestibular deafferentation as profound as possible, evidenced with multifrequency vestibular assessment. Sixty four patients with intractable MD in situation of medical treatment failure longer than 6 months were included between 1998 and 2013 in this case control study. A 2-year follow-up was performed after the last intratympanic gentamicin performed with the titration technique. A vestibular assessment was applied before and after 2 years of treatment with a functional level score using the AAOHNS vertigo scale and multifrequency vestibular assessment: skull vibration-induced nystagmus test (SVINT), head-shaking test (HST) and caloric test (CaTe). The correlation between the results of the questionnaire and the level of the deafferentation as evaluated by the tests was analyzed with the Spearman test. Among the 64 included patients, 56 (87.5 %) described vertigo control. There was a correlation (=−0.33 [−0.53; −0.09], p = 0.008) between subjective improvement (AAO -HNS 1 or 2) and the degree of vestibular deafferentation as evidenced by a destructive nystagmus (beating toward the safe side) with the HST and the SVINT, as well as a caloric hypofunction >90 % with the CaTe. The present study demonstrates that a profound vestibular deafferentation confirmed with multifrequency test evaluation is needed to have a subjective improvement in the treatment of unilateral disabling MD with intratympanic gentamicin.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Silverstein H, Smouha E, Jones R (1989) Natural history vs. surgery for Menière’s disease. Otolaryngol Head Neck Surg 100:6–16

    Article  CAS  PubMed  Google Scholar 

  2. (1995) Committee on hearing and equilibrium guidelines for the diagnosis and evaluation of therapy in Menière’s disease. American Academy of Otolaryngology-Head and Neck Foundation, Inc. Otolaryngol Head Neck Surg 113:181–185

  3. Reid CB, Eisenberg R, Halmagyi GM, Fagan PA (1996) The outcome of vestibular nerve section for intractable vertigo: the patient’s point of view. Laryngoscope 106:1553–1556

    Article  CAS  PubMed  Google Scholar 

  4. Magnan J, Bremond G, Chays A et al (1991) Vestibular neurotomy by retrosigmoid approach: technique, indications, and results. Am J Otol 12:101–104

    Article  CAS  PubMed  Google Scholar 

  5. Hillman TA, Chen DA, Arriaga MA (2004) Vestibular nerve section versus intratympanic gentamicin for Meniere’s disease. Laryngoscope 114:216–222

    Article  PubMed  Google Scholar 

  6. Yazdi AK, Rutka J (1996) Results of labyrinthectomy in the treatment of Menière’s disease and delayed endolymphatic hydrops. J Otolaryngol 25:26–31

    CAS  PubMed  Google Scholar 

  7. Gacek RR, Gacek MR (1996) Comparison of labyrinthectomy and vestibular neurectomy in the control of vertigo. Laryngoscope 106:225–230

    Article  CAS  PubMed  Google Scholar 

  8. Atlas JT, Parnes LS (1999) Intratympanic gentamicin titration therapy for intractable Meniere’s disease. Am J Otol 20:357–363

    CAS  PubMed  Google Scholar 

  9. Chia SH, Gamst AC, Anderson JP, Harris JP (2004) Intratympanic gentamicin therapy for Ménière’s disease: a meta-analysis. Otol Neurotol 25:544–552

    Article  PubMed  Google Scholar 

  10. Zhai F, Liu J-P, Dai C-F et al (2010) Evidence-based modification of intratympanic gentamicin injections in patients with intractable vertigo. Otol Neurotol 31:642–648

    PubMed  PubMed Central  Google Scholar 

  11. Silverstein H, Wazen J, Van Ess MJ et al (2010) Intratympanic gentamicin treatment of patients with Ménière’s disease with normal hearing. Otolaryngol Head Neck Surg 142:570–575

    Article  PubMed  Google Scholar 

  12. Morel N, Dumas G, Righini C et al (2008) Multifrequency vestibular study after vestibular neurotomy and chemical labyrinthectomy. Ann Otolaryngol Chir Cervicofac 125:139–145

    Article  CAS  PubMed  Google Scholar 

  13. Gode S, Celebisoy N, Akyuz A et al (2011) Single-shot, low-dose intratympanic gentamicin in Ménière disease: role of vestibular-evoked myogenic potentials and caloric test in the prediction of outcome. Am J Otolaryngol 32:412–416

    Article  CAS  PubMed  Google Scholar 

  14. Rohrmeier C, Richter O, Schneider M et al (2013) Triple test as predictive screen for unilateral weakness on caloric testing in routine practice. Otol Neurotol 34:297–303

    Article  PubMed  Google Scholar 

  15. Hain TC, Fetter M, Zee DS (1987) Head-shaking nystagmus in patients with unilateral peripheral vestibular lesions. Am J Otolaryngol 8:36–47

    Article  CAS  PubMed  Google Scholar 

  16. Curthoys IS, Burgess AM, MacDougall HG et al (2009) Testing human otolith function using bone-conducted vibration. Ann N Y Acad Sci 1164:344–346

    Article  CAS  PubMed  Google Scholar 

  17. Dumas G, Karkas A, Perrin P et al (2011) High-frequency skull vibration-induced nystagmus test in partial vestibular lesions. Otol Neurotol 32:1291–1301

    Article  PubMed  Google Scholar 

  18. MacDougall HG, Weber KP, McGarvie LA et al (2009) The video head impulse test: diagnostic accuracy in peripheral vestibulopathy. Neurology 73:1134–1141

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Weber KP, MacDougall HG, Halmagyi GM, Curthoys IS (2009) Impulsive testing of semicircular-canal function using video-oculography. Ann N Y Acad Sci 1164:486–491

    Article  PubMed  Google Scholar 

  20. Bartl K, Lehnen N, Kohlbecher S, Schneider E (2009) Head impulse testing using video-oculography. Ann N Y Acad Sci 1164:331–333

    Article  PubMed  Google Scholar 

  21. De Waele C, Meguenni R, Freyss G et al (2002) Intratympanic gentamicin injections for Meniere disease: vestibular hair cell impairment and regeneration. Neurology 59:1442–1444

    Article  PubMed  Google Scholar 

  22. Picciotti PM, Fiorita A, Di Nardo W et al (2005) VEMPs and dynamic posturography after intratympanic gentamycin in Menière’s disease. J Vestib Res 15:161–168

    PubMed  Google Scholar 

  23. Young Y-H (2006) Vestibular evoked myogenic potentials: optimal stimulation and clinical application. J Biomed Sci 13:745–751

    Article  PubMed  Google Scholar 

  24. Halmagyi GM (2005) Diagnosis and management of vertigo. Clin Med 5:159–165

    Article  CAS  Google Scholar 

  25. Seemungal BM, Bronstein AM (2008) A practical approach to acute vertigo. Pract Neurol 8:211–221

    Article  PubMed  Google Scholar 

  26. Perez N, Rama-Lopez J (2005) Vestibular function at the end of intratympanic gentamicin treatment of patients with Ménière’s disease. J Vestib Res 15:49–58

    PubMed  Google Scholar 

  27. Todd NPM, Rosengren SM, Colebatch JG (2009) A utricular origin of frequency tuning to low-frequency vibration in the human vestibular system? Neurosci Lett 451:175–180

    Article  CAS  PubMed  Google Scholar 

  28. Dumas G, Perrin P, Schmerber S (2008) Nystagmus induced by high frequency vibrations of the skull in total unilateral peripheral vestibular lesions. Acta Otolaryngol 128:255–262

    Article  PubMed  Google Scholar 

  29. Dimitri PS, Wall C, Rauch SD (2001) Multivariate vestibular testing: laterality of unilateral Ménière’s disease. J Vestib Res 11:405–412

    PubMed  Google Scholar 

  30. Black FO, Kitch R (1980) A review of vestibular test results in Meniere’s disease. Otolaryngol Clin North Am 13:631–642

    CAS  PubMed  Google Scholar 

  31. Ulmer E, Magnan J, Chays A (2002) Bilateral vestibular areflexia: quantification is required. Ann Otolaryngol Chir Cervicofac 119:216–226

    CAS  PubMed  Google Scholar 

  32. Bodmer D, Morong S, Stewart C et al (2007) Long-term vertigo control in patients after intratympanic gentamicin instillation for Ménière’s disease. Otol Neurotol 28:1140–1144

    Article  PubMed  Google Scholar 

  33. Manzari L, Tedesco A-R, Burgess AM, Curthoys IS (2010) Ocular and cervical vestibular-evoked myogenic potentials to bone conducted vibration in Ménière’s disease during quiescence vs during acute attacks. Clin Neurophysiol 121:1092–1101

    Article  CAS  PubMed  Google Scholar 

  34. Proctor LR (2000) Results of serial vestibular testing in unilateral Ménière’s disease. Am J Otol 21:552–558

    CAS  PubMed  Google Scholar 

  35. Diamond C, O’Connell DA, Hornig JD, Liu R (2003) Systematic review of intratympanic gentamicin in Meniere’s disease. J Otolaryngol 32:351–361

    Article  PubMed  Google Scholar 

  36. Huon L-K, Fang T-Y, Wang P-C (2012) Outcomes of intratympanic gentamicin injection to treat Ménière’s disease. Otol Neurotol 33:706–714

    Article  PubMed  Google Scholar 

  37. Pullens B, van Benthem PP (2011) Intratympanic gentamicin for Ménière’s disease or syndrome. Cochrane Database Syst Rev 16:CD008234

    Google Scholar 

  38. Cohen-Kerem R, Kisilevsky V, Einarson TR et al (2004) Intratympanic gentamicin for Menière’s disease: a meta-analysis. Laryngoscope 114:2085–2091

    Article  CAS  PubMed  Google Scholar 

  39. Okuda T, Sugahara K, Shimogori H, Yamashita H (2004) Inner ear changes with intracochlear gentamicin administration in Guinea pigs. Laryngoscope 114:694–697

    Article  PubMed  Google Scholar 

  40. Harner SG, Driscoll CL, Facer GW et al (2001) Long-term follow-up of transtympanic gentamicin for Ménière’s syndrome. Otol Neurotol 22:210–214

    Article  CAS  PubMed  Google Scholar 

  41. Kimura RS, Lee KS, Nye CL, Trehey JA (1991) Effects of systemic and lateral semicircular canal administration of aminoglycosides on normal and hydropic inner ears. Acta Otolaryngol 111:1021–1030

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Otolaryngology-Head and Neck Surgery, University of Grenoble, Grenoble, France

    Philippe Junet, Georges Dumas, Jean Louis Quesada & Sébastien Schmerber

  2. Department of Otolaryngology-Head and Neck Surgery, University of Saint-Etienne, Saint-Etienne, France

    Alexandre Karkas

  3. Department of Oto-Rhino-Laryngology, University Hospital of Grenoble, CHU A. Michallon, BP 217, 38043, Grenoble cedex 09, France

    Sébastien Schmerber

Authors
  1. Philippe Junet
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alexandre Karkas
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Georges Dumas
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jean Louis Quesada
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sébastien Schmerber
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sébastien Schmerber.

Ethics declarations

Conflict of interests

The authors declare that they have no conflict of interests.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Junet, P., Karkas, A., Dumas, G. et al. Vestibular results after intratympanic gentamicin therapy in disabling Menière’s disease. Eur Arch Otorhinolaryngol 273, 3011–3018 (2016). https://doi.org/10.1007/s00405-015-3889-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-015-3889-x

Keywords

Search

Navigation