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At least 469 records · Page 26Linked to original sources
PubMed2004

[Intratympanic dexamethasone injections for intractable Meniere's disease].

OBJECTIVE: To investigate the efficacy of intratympanic dexamethasone injections (IDI) for 15 patients with intractable Meniere's disease (MD). METHOD: Dexamethasone (2.5 mg/0.5 ml) was injected into the middle ear and followed by a second injection 15 minutes later. The injection was repeated the next day and weekly for 3 weeks. Total dose of dexamethasone was 17.5 mg. RESULT: The 15 patients were followed up for 18 months (average). Complete relief of vertigo was maintained in 10 cases, improved in 2 case, injection wos repeated 3 patients with recurrent vertigo resulted in control of vertigo. Tinnitus disappeared in 5 cases, reduced in 5 cases, unchanged in 5 cases. Hearing was improved in 10 cases, unchanged in 5 cases. CONCLUSION: IDI is effective for intractable MD. The benefits of IDI are avoidance of systemic use of steroids, lower cost, easy application. IDI can be used as an initial surgical treatment for persistent vertigo in MD and indicated for bilateral MD.

Adult↗
PubMed2004

Surgical management of special cases of intractable Meniere's disease: unilateral cases with intact canals and bilateral cases.

If a clinician seeks to allow patients with vertigo to return to work as soon as possible, it is very important to determine the appearance of vestibular symptoms during convalescence just after treatment, as well as the long-term results. Apprehensive patients with vertigo may undergo severe psychological torment if treatment requires long-term rest in bed before they can return to daily life. In this paper, we observed postoperative vestibular symptoms (subjective sensation and objective nystagmus) in 50 patients with intractable Meniere's disease, including cases from our previous preliminary report, during the period of convalescence just after endolymphatic sac drainage and steroid instillation surgery (EDSS). All symptoms were eliminated within 8 days after EDSS. There was no significant difference in the duration of any vestibular symptoms between bilateral (n = 8) and unilateral cases (n = 42). This result indicates that EDSS could be as safe a treatment for bilateral Meniere's disease as for unilateral disease. In unilateral cases with intact semicircular canal function (n = 17), postoperative evoked vestibular sensation, positional, and positioning (Dix-Hallpike) nystagmus disappeared significantly earlier than in those with canal paresis (n = 25). This result indicates that EDSS could keep the vestibular peripheral function of patients with unilateral Meniere's disease with intact canals quite stable after surgery. Therefore, EDSS could be recommended as an initial, less-invasive surgical treatment for intractable Meniere's disease, especially in unilateral cases with intact canals and in bilateral cases.

Dexamethasone↗
PubMed2002

Endolymphatic sac surgery for Meniere's disease: experience with over 3000 cases.

The foregoing discussion has attempted to substantiate and clarify the six propositions outlined at the outset in light of the author's personal experience. In sum, the following points are emphasized: Employment of ESS for treatment of intractable Meniere's disease in cases where the sac is definitively delineated, the real sac lumen entered, the sac's integrity preserved, and sac enlargement technique is employed has an approximate 90% chance of achieving complete or substantial control of vertigo in the short run (2-3 years). Although there seems to be little likelihood of pushing the short-term rate of vertigo control obtainable with ESS significantly beyond the 90% mark, there is still room for improvement of longer-term control of Meniere's disease symptoms, either through modification of surgical procedure or, as the author recommends, through treatment at an early stage of the disease. The efficacy of ESS almost certainly has a definite, although presently ill-understood, pathophysiologic basis and cannot be purely attributable to a placebo effect. Regardless of limitations and uncertainties surrounding Meniere's disease and treatment of it, ESS is indisputably both safe and highly effective and, in the author's opinion, continues to be the preferred treatment for medically refractory Meniere's symptom-complex.

Audiometry, Evoked Response↗
PubMed1999

Effect of intratympanic gentamicin on hearing and tinnitus in Meniere's disease.

OBJECTIVE: The objective of this study was to examine the effect of intratympanically applied gentamicin (GM) (30 mg/mL) on hearing and tinnitus in patients with intractable Meniere's disease. STUDY DESIGN: A prospective study was conducted on 93 subjects treated with intratympanically applied GM. The mean pure-tone average (PTA) at speech frequencies was measured before the treatment and after 2 weeks, 1 month, 3 months, 6 months, 1 year, and 2 years after injections. Tinnitus was surveyed with a questionnaire. The mean duration of Meniere's disease was 9.8 years (range, 1-33 years). PATIENTS: The study group consisted of 28 men and 65 women. The mean age was 50.9 years (range, 19-74 years). RESULTS: The mean PTA at speech frequencies for the group worsened from 60 dB to 68 dB, which was statistically significant. Ten ears were deafened. The mean tinnitus handicap score before treatment was 2.92; 2 years after treatment, it was 2.26, indicating significant abatement of tinnitus during the course of the treatment. CONCLUSIONS: The authors found that the average frequency of deafening was 10% and it was dose dependent. GM caused alleviation of tinnitus in the majority of the patients.

Administration, Topical↗
PubMed2005

Effects of intratympanic injection of latanoprost in Meniere's disease: a randomized, placebo-controlled, double-blind, pilot study.

OBJECTIVE: To determine the short-term effects of latanoprost, a selective FP prostanoid receptor agonist, in Meniere's disease. STUDY DESIGN AND METHODS: Latanoprost was administered by intratympanic injection once daily for 3 days. Before the first injection (day 1) and on days 5 and 15, hearing and tinnitus were determined. The patients assessed vertigo on a visual analogue scale on days 1-15. The study was randomized, double-blind, and placebo-controlled. RESULTS: Latanoprost reduced vertigo/dysequilibrium around 30% (P < 0.05), and improved speech discrimination around 15% (P < 0.05). Tinnitus loudness deteriorated after injection of placebo (P < 0.01) but not after latanoprost. Side effects were few. CONCLUSION AND SIGNIFICANCE: Latanoprost alleviated vertigo/dysequilibrium and improved hearing. The results indicate that the drug potentially could be useful for treatment of Meniere's disease.

Adult↗
PubMed1979

A critical evaluation of the glycerol test in Meniere's disease.

From the literature it is apparent that the glycerol test is being used frequently to evaluate Meniere patients, with regard to the choice of treatment, and in particular to find those who are suitable for surgery with different decompressive procedures. In our previous investigations on such patients we found that they often are extremely good placebo responders and it was natural to evaluate how important such psychological factors would be for the outcome of the glycerol test. In a group of patients with typical objective and subjective symptoms of Meniere's disease, the glycerol test was applied twice to each patient. In one of the tests, the patient was told that we would expect hearing to improve. In the other test, where the actual amount of glycerol was the same, we had the solution prepared with a different taste, and the patient was informed that we now would expect the hearing to deteriorate. The sequence of the two tests was randomly chosen for each patient. Most frequently the patient would follow our instructions, i.e. obtained a poorer hearing threshold when instructed to, and vice versa. The results are discussed with a special view to the risk of selection of suggestion-sensitive patients by this test.

Adult↗
PubMed1998

Sensitivity and specificity of transtympanic electrocochleography in Meniere's disease.

Transtympanic electrocochleography (TT ECoG) was conducted in 61 patients (61 ears) with the clinical diagnosis of Meniere's disease and 15 patients (21 ears) with cochlear hearing loss of other aetiologies to assess the ability of the method to separate different cochlear disorders. The click-evoked summation potential/action potential (SP/AP) ratio and the 1 and 2 kHz burst-evoked SP amplitudes were evaluated. Based on the TT ECoG results from 13 normal hearing subjects (15 ears) the upper limit of each variable was determined, above which a value was considered pathological, i.e. indicative of endolymphatic hydrops. The results showed that the sensitivity of the SP/AP ratio was 62% and specificity 95%. When evaluating the combinations of TT ECoG parameters with logistic regression, SP/AP ratio and 1 kHz burst-evoked SP amplitude were shown to increase the discriminating ability of TT ECoG significantly. Inclusion of the 1 kHz burst-evoked SP amplitudes increased sensitivity to 82%, without changing specificity. Inclusion of the 2 kHz burst had no effect on sensitivity or specificity.

Adult↗