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  • Title: Intratympanic gentamicin for Meniere's disease: short- and long-term follow-up of two regimens of treatment.
    Author: Casani AP, Cerchiai N, Navari E, Dallan I, Piaggi P, Sellari-Franceschini S.
    Journal: Otolaryngol Head Neck Surg; 2014 May; 150(5):847-52. PubMed ID: 24477826.
    Abstract:
    OBJECTIVES: (1) To compare the results of the 2 regimens of treatment at 2-year follow-up and (2) to evaluate the need and the efficacy of retreatment after the recurrence of vertigo attacks in a longer period of follow-up (using the Kaplan-Meier method of analysis). STUDY DESIGN: Retrospective chart review. SETTING: Tertiary referral center. SUBJECTS AND METHODS: We analyzed 77 patients treated with intratympanic gentamicin (ITG). Thirty-five patients were treated with high-dose (HD) ITG (in total 6 injections, twice a day, repeated every 3 days) and 42 with low-dose (LD) ITG (1-2 injections). The results of treatment were evaluated in terms of functional level scale, control of vertigo, and hearing impairment. RESULTS: At 2-year follow-up, a similar percentage of vertigo control was obtained in the 2 groups; the incidence of hearing loss and posttreatment disequilibrium was significantly higher in patients treated with HD-ITG. The long-term follow-up showed a control of vertigo attacks with a single round of treatment in 71.4% of patients treated with HD-ITG and in 55% of those treated with LD-ITG. With repeated rounds, an effective control of vertigo could be achieved in 88.5% using a HD-ITG protocol and 97.7% using a LD-ITG protocol. CONCLUSIONS: LD-ITG allows obtaining good results in term of vertigo attacks associated with a limited occurrence of side effects. The long-term follow-up showed that LD-ITG needed repeated rounds more frequently than the HD-protocol. HD-ITG ran less risk of needing repeated rounds, but retreatment was ineffective in 40% of the cases requiring surgical therapy.
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