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Literature Review: A roundup of important recent studies

Gentamicin vs. Dexamethasone in Meniere’s Disease

Does intratympanic gentamicin or dexamethasone control vertigo in patients with intractable, unilateral Meniere’s disease?

Background: Intratympanic gentamicin demonstrates good control of vertigo but significant incidence of hearing loss and prolonged imbalance associated with higher dosing protocols. Intratympanic steroids have varied control rates of vertigo with a low risk of side effects.

Study design: Prospective, randomized, controlled study.

Setting: Tertiary referral center.

Synopsis: Sixty patients with at least six months of unilateral definite Meniere’s disease (AAO-HNS 1995) refractory to medical management were randomized to two treatment groups: low-dose intratympanic gentamicin (ITG) or intratympanic dexamethasone (ITD). Low-dose ITG treatment was defined as 2 mL of 27.6 mg/mL (40 mg/mL buffered). A second treatment was given 20 days later if there were no signs of vestibular dysfunction or significant reduction in calorics. Nineteen patients received one ITG treatment and 13 received the second treatment. Intratympanic administration of dexamethasone was defined as 4 mg/mL once every three days for a total of three injections. Four patients received one retreatment and five patients received two retreatments for uncontrolled vertigo.

Vertigo control was calculated using AAO-HNS 1995 (classes A through F). Two-year follow-up for the ITG group revealed 81 percent complete control (class A) and 12 percent substantial control (class B). In the ITD group, 43 percent obtained complete control (class A) and 18 percent substantial control (class B).

Hearing loss in the ITD group was strictly related to the progression of Meniere’s disease, that is, only in patients who had poor control of vertigo. For the ITG group, 12 percent had increased hearing loss likely attributable to gentamicin.

Bottom line: In patients with refractory, unilateral Meniere’s disease, low-dose intratympanic gentamicin is relatively effective in controlling vertigo and has a low incidence (12 percent) of hearing loss. Intratympanic dexamethasone 4 mg/mL is less effective in controlling vertigo, similar to placebo, and did not influence hearing loss.

Reference: Casani AP, Piaggi P, Cerchiai N, et al. Intratympanic treatment of intractable unilateral Meniere’s disease: gentamicin or dexamethasone? A randomized controlled trial. Otolaryngol Head Neck Surg. 2012;146(3):430-437.

—Reviewed by Larry Lundy, MD

 

Flying after Tympanoplasty

Does early commercial air travel after tympanoplasty affect graft take rates?

Background: Patients are typically advised to avoid flying after tympanoplasty due to the potential for graft displacement with altitude changes. However, financial and personal reasons often necessitate flying home immediately after surgery.