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PubMed1999

Intratympanic gentamicin titration therapy for intractable Meniere's disease.

OBJECTIVE: This study aimed to assess the efficacy and morbidity of intratympanic gentamicin titration therapy on patients with intractable unilateral Meniere's disease. STUDY DESIGN: The study design was a retrospective chart review and patient interviews. SETTING: The study was conducted at a tertiary referral ambulatory dizziness clinic at the London Health Sciences Centre, University Campus, from July 1992 to June 1997. INTERVENTION: Eighty-three patients received weekly intratympanic gentamicin injections in their diseased ear. Treatments were terminated after four injections or sooner if patients met clinical or audiologic criteria. Sixty-eight patients were available for detailed follow-up. MAIN OUTCOME MEASURES: Vertigo frequency, hearing status, personal disability ratings, tinnitus level, and caloric responses before and after gentamicin therapy were measured. RESULTS: Eighty-four percent of patients showed complete, and an additional 6% showed substantial, vertigo control. At 24 months, 17% of patients demonstrated a clinically significant (10-dB) reduction in hearing, but 26% showed a significant hearing improvement. Overall, the group showed no combined statistically significant changes in any of the hearing parameters. No patients had an "extreme" drop in hearing (>30 dB). CONCLUSIONS: Intratympanic gentamicin titration therapy provides excellent vertigo control with a low incidence of hearing loss.

Adult↗
PubMedDate not supplied

A comparison of the furosemide and glycerol tests for Meniere's disease. With special reference to the bilateral lesion.

The feasibility of furosemide test for the detection of endolymphatic hydrops has previously been discussed (Authors, 1973, 1975). The glycerol test also has been reported as being effective for the same purpose but only in Meniere patients with fluctuating hearing loss (Klockhoff & Lindblom, 1966). In 48 patients with Meniere's disease, both the furosemide test (F-test) and the glycerol test (G-test) were performed on 51 ears including 3 cases of bilateral involvement. The average value of urine volume in the F-test was significantly greater than that for the G-test. The decrease in tinnitus was 40% in the former, 45% in the latter. The F-test yielded a positive rate of 73%, and the G-test, 45%. The results were thus: positive in the both tests, i.e., F+: G+ were 17 (33%); F+: G-, 20 (39%); F-: G+, 6 (12%), and both negative, F-: G-, only (16%). The side effects of the F-test were nil, but those of the G-test were as follows: headache (29%), nausea (4%), and increase in tinnitus (9%). The response increase of the hydropic labyrinth caused by the two kinds of systemic dehydration over-lapped in part and differed in part, as a result of the differing diuretic mechanisms and their respective affinities to the cochlea and the vestibulum. The furosemide test may be based on the action of the vestibular response type, which is caused by natriuretic dehydration accompanying the more sensitive response increase in caloric-induced nystagmus, while the glycerol test may be based on the action of the cochlear response type, owing to osmotic diuresis manifested as hearing shift. The correlation between labyrinthine hydrops and dehydration was discussed and it was concluded that these double test were quite adequate methods for choice of treatment of not only unilateral Meniere's disease in its various stages but also in bilateral involvements.

Administration, Oral↗
PubMed1984

Medical treatment of fluctuant hearing loss in Meniere's disease.

Fluctuations in hearing are thought to reflect varying degrees of endolymphatic hydrops. Spontaneous fluctuations are often reported by patients with idiopathic Meniere's disease and have been verified by audiometry in more than 50% of cases. The hearing loss occurs mainly during the first 5 to 10 years of the disease. It is therefore important to commence therapy, regardless of type, at an early stage. The varying course of the disease makes it difficult to assess the effect of medical treatment. Widely accepted recommendations include special diet, salt restriction, diuretics, corticosteroids, and vasodilators. Among diuretics, benzthiazides, potassium-sparing types, and furosemide have been considered beneficial. Transient improvement in hearing can be achieved by osmotic expanders such as glycerol, urea, mannitol, and isosorbide. Glycerol and urea have been widely used as test substances for confirmation of suspected endolymphatic hydrops. Urea and isosorbide, both of which can be taken orally, have also been used for medication.

Administration, Oral↗
PubMed1983

Placebo effect in surgery for Meniere's disease: three-year follow-up.

In 1981 we published the results of a double-blind, placebo-controlled study in which the efficacy of a regular endolymphatic sac mastoid shunt was compared with a purely placebo operation (mastoidectomy) in controlling the symptoms of 30 patients with typical Meniere's disease. Minor differences could be demonstrated between the shunt and the sham operation, but the greatest difference was between the preoperative and postoperative scores, and both groups improved significantly. It was concluded that the impact of the various endolymphatic sac shunts on the symptoms of patients with Meniere's disease is nonspecific, and that the 70% improvement in both groups was most likely caused by a placebo effect. At the time of the presentation, the results were based on a 1-year follow-up of all patients. As of January 1982 the patients had been followed for a minimum of 3 years. The 3-year results are the same as our results from the first year: no significant difference could be found between the two groups.

Adult↗
PubMed1997

Outcome-based assessment of endolymphatic sac surgery for Meniere's disease.

This study reports the preliminary results of an outcomes approach to analysis of the effectiveness of endolymphatic sac decompression (ELSD). Using the medical outcomes survey's 36-item, short-form health survey (SF-36), we assessed the quality of life in 33 patients with disabling Meniere's disease undergoing ELSD for medically intractable vertigo. Results indicate that patients with 1995 American Academy of Otolaryngology--Head and Neck Surgery (AAO/HNS) class A or B outcomes showed no significant difference from population norms on the SF-36, whereas patients with AAO/HNS classes C to E outcomes scored significantly below norms. Six patients who were given the SF-36 preoperatively scored consistently below population norms. Postoperatively, they showed a statistically significant improvement and were statistically equal to norms. These findings suggest that the SF-36 is a good measure of the quality of life impairment in patients with disabling Meniere's disease. In addition, SF-36 scores correlated well with the 1995 AAO/HNS classification.

Adult↗
PubMed2005

Treatment of Meniere's disease with the low-pressure pulse generator (Meniett device).

Until recently, surgery was the only treatment option for people with disabling Meniere's disease that did not respond to adequate medical therapy. A new intermediate level treatment modality, the Meniett device, which applies low-pressure micropulses to the inner ear, has now been shown to be safe and effective. The device is portable and self-administered, requiring a 5-min three-times daily application for an indefinite period. Placement of a tympanostomy tube in the ear drum of the affected ear is necessary. Patient acceptance has been high. Long-term success in control of vertigo is over 80%. Although hearing loss is not improved, Meniett device usage does not adversely affect balance, as do most forms of surgical therapy. Use of the device does not preclude later surgical therapy.

Clinical Trials as Topic↗
PubMed2003

Intratympanic gentamicin for intractable Meniere's disease: 5-year follow-up.

OBJECTIVE: To determine the efficacy and morbidity of intratympanic gentamicin titration therapy on patients with incapacitating unilateral Meniere's disease. METHOD: The study consisted of a retrospective chart review and patient interviews. Sixty-eight patients had been followed for a minimum of 24 months and were reported on in an earlier study. Forty-six of these individuals were available for detailed follow-up at 5 years post-gentamicin therapy. MAIN OUTCOME MEASURES: Vertigo frequency, hearing status, personal disability ratings, and tinnitus level before and after gentamicin therapy were measured. RESULTS: Seventy-four percent of patients showed complete vertigo control and an additional 7% showed substantial vertigo control. There was also significant improvement in personal ratings of social and economic functioning. Overall, the group showed no combined statistically significant changes in any of the hearing parameters. CONCLUSION: Intratympanic gentamicin titration therapy provides excellent vertigo control, with a similarly significant improvement in both personal and occupational functioning.

Anti-Bacterial Agents↗
PubMed2001

Analysis of lifestyle and behavioral characteristics in Meniere's disease patients and a control population.

A questionnaire was devised to quantify and measure four categories: the behavioral characteristics of Type A, self-restraint and escape; the causes of anxiety; means of relaxation; and symptoms incidental to anxiety. Questionnaire analysis was performed in patients (n = 60) with Meniere's disease and in a control population (n = 936). It was statistically proven that the patient group possessed a stress-causative tendency in behavioral characteristics, felt stronger anxiety and showed more severe symptoms owing to this anxiety. Since the level of anxiety highly correlates with the score of behavioral characteristics and also with severity of symptoms, it seems likely that behavioral characteristics produce the anxiety, which, in turn, results in various symptoms of autonomic nervous disorders. A tendency towards stress-causative behavioral characteristics in Meniere's disease patients may be important in the genesis of endolymphatic hydrops.

Adaptation, Psychological↗