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Biomedical subjects

Eduardo Martin

Publications and source records attributed to Eduardo Martin.

6 recordsLinked to original sources
PubMed2005

Distortion product otoacoustic emissions after intratympanic gentamicin therapy for unilateral Ménière's disease.

The treatment of patients with Ménière's disease that do not respond to conventional therapy becomes complicated, particularly when taking into account the issue of hearing damage as well as the control of vertigo. Treatment often involves the intratympanic administration of gentamicin, for which different protocols are used. Hence, it is important that we better understand how this treatment influences hearing, beyond mere audiometric assessments. The aim of this prospective study was to evaluate the effect of intratympanic gentamicin treatment for Ménière's disease on cochlear function, as assessed by otoacoustic emissions. The 41 patients included in the study had been diagnosed with unilateral Ménière's disease as defined by the American Academy of Otolaryngology-Head and Neck Surgery guidelines (1995), and had been refractory to medical treatment for at least 1 year. Intratympanic injections of gentamicin at a concentration of 27 mg/ml were performed at weekly intervals until indications of vestibular hypofunction appeared in the treated ear. Before beginning the treatment and 3 months after ending it, pure tone and speech audiometry tests were performed and the results are expressed in terms of the pure tone average (0.5, 1, 2, and 3 kHz) and the speech discrimination score, respectively. At the same time, a distortion product otoacoustic emission (DPOAE) study was performed and the results are expressed in terms of its presence or absence, and as the amplitude and threshold of the emission. When analyzed 3 months after the treatment had terminated, hearing loss was seen in 13 patients (31.7%). However, no significant change in the threshold and/or amplitude of otoacoustic emissions was observed in any of the patients. Neither were changes in the audiometric stage, number of injections required or the existence of DPOAE before treatment detected. Hence, the treatment method used here for patients with intractable unilateral Ménière's disease can be considered as having a low risk on auditory function, as assessed both audiometrically and with otoacoustic emissions, and can be considered as subablative for hearing function.

Anti-Bacterial Agents↗
PubMed2003

Dizziness: relating the severity of vertigo to the degree of handicap by measuring vestibular impairment.

OBJECTIVE: We sought to correlate the severity of vertigo and handicap in patients with vestibular pathology according to measures of impairment. STUDY DESIGN AND SETTING: We conducted a prospective assessment of patients with dizziness by means of caloric, rotatory test, and computerized dynamic posturography to estimate impairment. Handicap and severity of vertigo were determined with specific questionnaires (Dizziness Handicap Inventory and UCLA-DQ). RESULTS: A fair relationship were found between severity of dizziness and vestibular handicap. When impairment was taken into consideration, values were still fair and only moderate for a group of patients with an abnormal caloric test as the only pathologic finding. The composite score from the sensory organization test portion of the computerized dynamic posturography is fairly correlated to severity of vertigo and handicap in the whole population of patients, but no correlation was found when they were assigned to groups of vestibular impairment. CONCLUSION: To assess vestibular impairment, the results from several tests must be taken into account. However, vestibular handicap is not solely explained with measurements of impairment and/or severity.

Adult↗
PubMed2003

Results of vestibular autorotation testing at the end of intratympanic gentamicin treatment for Ménière's disease.

OBJECTIVE: The vestibular autorotation test (VAT) examines the ocular response to voluntary horizontal and vertical head movements at frequencies for which the vestibular system is the main source for eye stabilization. The purpose of this study was to analyse the VAT results in patients with disabling Ménière's disease and to evaluate the change in VAT values once treatment with intratympanic gentamicin had terminated and clinical signs of vestibular hypofunction could be observed. MATERIAL AND METHODS: The 30 study subjects were patients diagnosed with definitive unilateral Ménière's disease that could not be controlled with medication. The vestibulo-ocular reflexes of each patient were evaluated by means of the VAT before the first injection of gentamicin and after the last injection. RESULTS: The pattern of abnormalities found in this population conformed to the selection criteria and the findings reflected a severe disabling process, with major modifications in the vestibulo-ocular reflex. At the end of treatment there was a reduction in the peak frequency of head oscillation. Furthermore, we commonly found that, in the horizontal VAT, gain and phase were reduced while in the vertical VAT some subjects registered a normal response. The phase in the horizontal and vertical VATs was most significantly reduced for oscillation frequencies of 2-3.7 Hz. CONCLUSION: This study provides further evidence that effective control of vertigo in patients with Ménière's disease can be achieved by administering intratympanic gentamicin.

Anti-Bacterial Agents↗
PubMed2003

Hearing loss after intratympanic gentamicin therapy for unilateral Ménière's Disease.

OBJECTIVE: This study set out to evaluate the hearing changes that occur during intratympanic gentamicin therapy and to correlate them with the long-term effects of the treatment on the control of vertigo and on hearing. STUDY DESIGN: This was a prospective study. SETTING: Tertiary medical center. PATIENTS: The 71 patients included in the study had been diagnosed with unilateral Ménière's Disease as defined within the 1995 American Academy of Otolaryngology-Head and Neck Surgery guidelines, and had been refractory to medical treatment for at least 1 year. INTERVENTION: Intratympanic injections of gentamicin at a concentration of 27 mg/ml were performed at weekly intervals until indications of vestibular hypofunction appeared in the treated ear. If there was a recurrence of the episodes of vertigo, an additional course of injections was performed. MAIN OUTCOME MEASURE: The 1995 American Academy of Otolaryngology-Head and Neck Surgery criteria for reporting the treatment outcome for Ménière's Disease were used. During the period of gentamicin instillation, weekly audiograms were obtained. The results of the treatment were expressed in terms of control of vertigo and hearing level. RESULTS: Vertigo was controlled by gentamicin instillation in 83.1% of the 71 patients. Two years after the treatment, hearing loss as a result of the gentamicin injections was observed in only 11 (15.5%) patients. The recurrence of spells of vertigo after having initially achieved complete control was noted in 17 (23.9%) patients. Hearing loss at the end of the treatment occurred in 32.4% of the patients, but it was transitory so that 3 months after ending the treatment it was 12.7% and after 2 years it was 15.5%. Those patients in whom no change in their level of hearing occurred during the treatment needed another course of injections and presented poorer overall control of vertigo. CONCLUSIONS: Ending weekly intratympanic injections when clinical signs of vestibular deafferentation appear results in the control of vertigo in the majority of patients. The hearing changes detected during the treatment are transitory and are the only clinical sign that predicts the response to gentamicin instillation.

Audiometry↗
PubMed2002

Benign paroxysmal positional vertigo in patients with Ménière's disease treated with intratympanic gentamycin.

OBJECTIVES: To analyze the incidence and characteristics of benign paroxysmal positional vertigo (BPPV) in patients with Ménière's disease who did not respond to medical treatment and to whom intratympanic gentamycin treatment was proposed. STUDY DESIGN: This is a retrospective analysis of the patients in our database. A complete otoneurologic bedside examination of each patient, including assessment of positional nystagmus, was performed at the time of diagnosis and during the follow-up. RESULTS: Nine of 90 patients with Ménière's disease also had BPPV, which manifested in different ways. In 3 patients, BPPV preceded the onset of Ménière's symptomatology in the same ear; in 1, BPPV manifested after treatment for Meniere's disease had ended and the patient was in complete control of the spontaneous spells of vertigo; in 5 cases, recurrences of both Meniere's disease and the positioning symptomatology coincided. Treatment for each condition was conducted independently and favorable results were obtained after long-term follow-up when Meniere's disease and BPPV did not coincide simultaneously. In the group manifesting symptoms of both disorders at the same time, gentamycin treatment with the Canalith Repositioning Procedure and/or Semont maneuver partially resolved the symptoms. CONCLUSIONS: In the context of Ménière's disease, the sequence of appearance of BPPV relative to the spontaneous episodes must be taken into account when planning the treatment for each of the disorders, which should be considered independently. This pattern could also influence the prognosis for each disorder.

Adult↗