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At least 415 records · Page 23Linked to original sources
PubMed1997

Use of sustained release vehicles in the treatment of Meniere's disease.

Over the years, a variety of empirical regimens have evolved using intratympanic gentamicin to treat the vertigo associated with Meniere's disease. Although these regimens have been effective, their application is not without risk. Many of the problems associated with intratympanic medications could be overcome with the use of a sustained release vehicle. This article examines the role of such vehicles in the treatment of Meniere's disease and how sustained release vehicles might impact future treatment for this disabling disease.

Aminoglycosides↗
PubMedDate not supplied

Electronystagmographic and audiologic findings in patients with Meniere's disease.

Electronystagmographic (ENG) and audiologic findings were reviewed for 206 patients treated for Meniere's disease (MD) at the University of Washington Hospital over a 10-year period (1971-80). The most frequently seen ENG findings were unilateral caloric weakness (UW) in 49%, directional preponderance (DP) in 36%, and spontaneous and/or positional nystagmus (SN, PN) in 32%. ENG was normal in 25%. Bilateral caloric weakness (BW) occurred in 36% of patients with bilateral hearing loss. UW was reliably correlated with the side of audiometric involvement; after exclusion of bilateral cases, only 3% of patients showed UW contralateral to the ear with hearing los. Neither DP nor direction of SN or PN correlated at all with side of hearing loss. There was no significant correlation of severity of hearing loss (by pure-tone thresholds or speech discrimination score) with ENG abnormality (UW or DP). Glycerol-positive patients had significantly poorer hearing than glycerol-negative patients, but ENG findings were similar in the two groups.

Audiometry↗
PubMedDate not supplied

Meniere's disease and the mastoid pneumatization.

The size of the mastoid penumatization was radiographically examined and planimetrically measured in the patients with Meniere's disease, patients with other sensorineural hearing loss and clinically ear healthy persons. Law projection was used for the radiographical examination. No statistical differences were seen among the three groups. Meniere's disease and the factors which influence the mastoid pneumatization are discussed.

Adult↗
PubMed2003

Systematic review of intratympanic gentamicin in Meniere's disease.

OBJECTIVES: To assess and summarize the best available evidence for the use of intratympanic gentamicin in patients with Meniere's disease with respect to improvement of vertigo, tinnitus, and change in hearing. METHODS: Comprehensive electronic searches were conducted on the databases of MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials. All generated titles were reviewed, and potentially relevant articles were assessed for inclusion. Data from included articles were extracted and summarized. RESULTS: Overall pooled results on vertigo control revealed complete or substantial control in 89% of patients (study range 73-100%). Hearing was worsened in 26% (0-90%). Subjective improvement in tinnitus was seen in 57% of patients (0-82%). Different treatment protocols all resulted in similar rates of vertigo control. CONCLUSIONS: Intratympanic gentamicin appears effective in controlling the symptoms of Meniere's disease, regardless of the protocol used. Although the literature on this treatment is extensive, there is a likelihood of significant bias in many currently published reports. There is a clear need for a prospective, randomized, blinded, placebo-controlled trial to assess the true effectiveness of this treatment.

Administration, Topical↗
PubMed2002

Intentional ablation of vestibular function using commercially available topical gentamicin-betamethasone eardrops in patients with Meniere's disease: further evidence for topical eardrop ototoxicity.

OBJECTIVE: To determine whether the controversial findings of suspected ototoxicity from commercially available gentamicin sulfate and betamethasone sodium phosphate eardrops can be used in a therapeutic fashion to ablate (or attenuate) vestibular function in patients with unilateral Meniere's disease. STUDY DESIGN: Prospective case review. METHODS: At a tertiary care dizziness unit at the University Health Network, Toronto General Hospital, University of Toronto (Toronto, Ontario, Canada), adults with unilateral Meniere's disease undergoing intratympanic ablation therapy were studied. After insertion of a tympanostomy tube with the patient under local anesthesia, patients instilled gentamicin containing eardrops three times daily until they became vertiginous for longer than 24 hours and then for an additional 2 days longer or for 1 month, whichever came first. Electronystagmographic caloric test responses were measured before treatment using bithermal water caloric and after treatment using air caloric tests. Main outcome measures included clinical titration of drops to the onset of prolonged vertigo. As well, post-treatment findings on electronystagmography and audiometry were compared with pretreatment testing. RESULTS: Twenty patients were available for review. Fifteen patients had a significant reduction in caloric test responses compared with pretreatment values; among them, 10 patients had absent air caloric test responses on the treated side. In 10 patients hearing worsened according to the 1995 American Academy of Otolaryngology-Head and Neck Surgery Committee on Hearing and Equilibrium Guidelines for reporting in Meniere's disease. CONCLUSIONS: Topical gentamicin-betamethasone eardrops can pass through a tube into the middle ear, where they may prove primarily vestibulo-ototoxic patients with Meniere's disease. The study further confirms clinical observations that gentamicin-containing eardrops might prove ototoxic, especially in noninflamed ears with a tympanic membrane defect.

Administration, Topical↗
PubMedDate not supplied

Posterior fossa arachnoid cysts can mimic Meniere's disease.

Arachnoid cysts constitute 1% of all intracranial space-occupying lesions. In the posterior fossa, they typically produce vague, nonspecific symptoms. However, a subset of these lesions can produce signs and symptoms indistinguishable from those of Meniere's disease. We discuss the clinical and laboratory features of 2 cases of posterior fossa arachnoid cysts mimicking Meniere's disease as well as the substantial resolution of symptoms in 1 patient after cysto-peritoneal shunt. Posterior fossa arachnoid cyst must be considered in the differential diagnosis of patients presenting with signs and symptoms of Meniere's disease.

Arachnoid Cysts↗
PubMed2005

[Two cases of Meniere's disease with drop attacks].

Drop attacks are sudden falls without concurrent vertigo whose etiology may be unknown. Drop attacks are also associated with cardiac, cerebrovascular, psychogenic, and vestibular disorders, in addition to seizures. Vestibular-based drop attacks without loss of consciousness can occur in patients with Meniere's disease. We present 2 cases of drop attack in patients with Meniere's disease. Case 1, a 65-year-old man, experienced 4 such attacks and case 2, a 55-year-old woman, experienced 20 within 2 years of Meniere's disease onset. Case 1 enjoyed spontaneous remission. In case 2, selective serotonin reuptake inhibitor (SSRI) administration suppressed attack frequency. Anxiety may predispose individuals to drop attack. Etiologically, inadequate stimulation of otolith organs may induce a sudden vestibulo spinal reflex that, in turn, causes sudden falls. To correctly diagnose drop attacks, the patient must exhibit sudden falls, and transient ischemic attack should be carefully ruled out.

Accidental Falls↗
PubMed2005

Local overpressure treatment reduces vestibular symptoms in patients with Meniere's disease: a clinical, randomized, multicenter, double-blind, placebo-controlled study.

OBJECTIVES: To evaluate the efficacy of a new device, the Meniett, in the treatment of Meniere's disease. The device delivers pressure pulses to the middle ear through a ventilating tube in the tympanic membrane at a frequency of 6 Hz for 0.6 second. After rising to a pressure level of 1.2 kPa, the pressure oscillates between 0.4 and 1.2 kPa. It is believed that the pressure changes are conveyed to the inner ear, inducing a transport of fluids via the pressure outlets and thus reducing the endolymphatic hydrops. STUDY DESIGN: A clinical, randomized, multicenter, double-blind, placebo-controlled study. A total of 40 patients were included that had active Meniere's disease according to American Academy of Otolaryngology-Head and Neck Surgery criteria, aged between 20 and 65 years, with a history of at least eight attacks during the past year. After insertion of the ventilation tube, the patients should have had attacks of vertigo for 2 months before entering the study. OUTCOME MEASURES: Primary study endpoints were change in frequency of vertigo, change of functionality profile, and change in patient perception of vertigo (visual analogue scale); secondary endpoints were perception of tinnitus, aural pressure, and hearing, as well as an audiologic evaluation of hearing before and after the treatment period. RESULTS: The functionality level improved statistically significantly in the active group compared with the placebo group (p=0.0014), as did the visual analogue scale evaluation of vertigo (p=0.005). There was a trend toward a reduction of the frequency of vertiginous attacks that was not significant (p=0.090). With regard to the secondary endpoints, there was no statistical difference between active and placebo groups. CONCLUSION: Local overpressure treatment is a novel treatment that is noninvasive, nondestructive, and safe. It significantly reduces vestibular symptoms in patients with Meniere's disease. The Meniett was cleared by the Food and Drug Administration in 2000.

Adult↗
PubMed1986

Noninvasive recordings of cochlear evoked potentials in Meniere's disease.

Noninvasive meatal electrocochleography simultaneously recorded with brain stem auditory evoked potentials were performed on 24 adult patients with unilateral Meniere's disease. Data from the affected ear were compared with those of the nonaffected ear and with those of ten healthy normally hearing adults. The most striking finding was the significant deviation from the norm of the nonaffected ears' action potential duration. The combination of simultaneously recorded surface meatal electrocochleography and brain stem auditory evoked potentials complement the diagnostic battery of Meniere's disease in ruling out retrocochlear involvement, indicating cochlear involvement of the affected ear, and revealing subclinical changes in the contralateral ears.

Adult↗
PubMedDate not supplied

Vascularity of endolymphatic sac in Meniere's disease. A histopathological study.

The vascularity of the endolymphatic sac (ES) in the vestibular aqueduct (VA) and of periaqueductal bony channels was studied in 18 temporal bones from patients with Meniere's disease and in the same number of control bones with no endolymphatic hydrops and no premortem history of otologic disease. The control bones were selected on the basis of having VAs of the same sizes as the hydropic bones. This was important in order to eliminate any possibility that differences in degree of vascularity of the ES could have been due simply to differences in the degree of development of the VA. All specimens were sectioned and stained with hematoxylin and eosin. The ES of each bone was reconstructed two-dimensionally by the medial view graphic reconstruction method, and its vascularity was studied histologically under a light microscope. There were fewer and smaller blood vessels in the ESs of bones from individuals with Meniere's disease than in the ESs of control bones. This was particularly true in the richly rugose and the cranial orifice portions of the sac. However, no significant differences were recognized in the degree of vascularity of the periaqueductal bony channels between control and Meniere's disease bones.

Adult↗