小剂量庆大霉素鼓室内注射治疗难治性梅尼埃病眩晕的临床研究

目的：分析小剂量庆大霉素鼓室内注射治疗难治性梅尼埃病眩晕的疗效。方法：19例单侧难治性梅尼埃病患者显微镜下鼓室内注射庆大霉素,根据床旁试验（自发性眼震、摇头实验、甩头试验）,听力变化或患者主观症状来决定3周后是否需要再次注射。结果：19例患者中17例眩晕能得到控制,眩晕控制率89％,其中5例患者经1次注射后眩晕就得到控制;8例患者2次注射后眩晕达到控制,其中1例患者因不能忍受耳内肿胀感,要求进一步治疗,行内淋巴囊减压后,症状缓减;有4例患者经3次注射后眩晕得到控制;另外2例患者注射2次后眩晕无改善,要求终止治疗。2例患者注射后听力好转,14例患者注射后听力无变化,3例患者（15％）注射后听力进一步下降。结论：运用小剂量鼓室内庆大霉素注射治疗难治性梅尼埃病眩晕,1次注射后观察3周决定再次注射的必要性,结果显示这一治疗方案既能有效控制眩晕的发作,又能降低听力损伤的风险。     

阿司匹林预防庆大霉素耳毒性的随机对照试验

目的观察阿司匹林对庆大霉素耳毒性的预防作用。方法设计实施多中心的随机双盲对照试验，预防组在应用庆大霉素的同时口服阿斯匹林2周，对照组口服安慰剂。用药前后检测纯音测听3次，对比听力损伤发生率。结果两组的血清庆大霉素水平相当，预防组的听力损伤发生率为3％（3／89），明显低于对照组的13％（14／106）（P＝0．013）。试验中阿司匹林没有影响到庆大霉素的血清药物水平和时程。结论同时伍用阿司匹林可以有效减轻庆大霉素的耳毒性损伤，氨基甙类抗生素的耳毒性防护研究已从动物实验走向临床。     

鼓室内注射庆大霉素治疗难治性梅尼埃病

目的探讨鼓室内注射庆大霉素治疗难治性梅尼埃病的方法、疗效及副反应。方法对10例(11耳)难治性梅尼埃病患者行鼓室内注射庆大霉素治疗,然后分析其眩晕控制情况以及听力的变化。结果10例患者均随访2年以上,眩晕控制A级8例,B级2例;听力改善B级1例,C级9例。结论鼓室内注射庆大霉素是治疗难治性梅尼埃病的有效方法,值得临床进一步深入研究、探讨。     

低浓度小剂量多次鼓室注射庆大霉素对单侧难治性梅尼埃病的疗效分析

目的 探讨低浓度小剂量多次鼓室注射庆大霉素对单侧难治性梅尼埃病患者的临床疗效及安全性.方法 回顾性分析2015年2月～2016年12月在威海市中医院耳鼻喉科行低浓度小剂量多次鼓室注射庆大霉素治疗的23例难治性梅尼埃病患者的临床资料,分析该方法对患者治疗前后眩晕、耳鸣、听力损失症状及对生活的影响.结果 23例难治性梅尼埃...     

庆大霉素治疗梅尼埃病的迟发耳毒效应

在欧洲和日本,鼓室内注射庆大霉素广泛应用于致残性梅尼埃病。氨基糖甙类药物在内耳排泄慢,用药后累进性的内耳结构损伤至少持续5天。短期内多次鼓室内注射该类药物有用药过量和听力损失之虞。作者观察了5例梅尼埃病,用脑CT排除中枢疾患;听功能、前庭功能检查均未提示有中枢病变。治疗前查自发性和位置性眼震及摆头试验。病人取卧位,表麻后经鼓膜注入硫酸庆大霉素(30mg/ml)0.9ml,注射后卧位60分钟。12小时后重复注射一次。治疗后定期查位听功能。5位患者在代偿后眩晕消失,随访期间无复发,未诉听力减退,但耳鸣无变化。第二次注射后患者无不适主诉,2～3天后诉不稳定感增加。治疗后3     

神经性耳聋耳鸣患者接受声信息治疗前后主观听力变化特点的临床研究

为了深入探讨根据个体差异刮用量化的声音，通过听觉器官作用于人体，治疗时觉功能障碍疾病的临床价值，将150例的神经性耳聋患者（其中129例伴有耳鸣）随机分成两组，进行声信息与常规药物治疗前后电测听主观听力变化对比观察，每天声信息治疗1次，每次约25分钟，连续10次，声信息组每次治疗前，对照组眼药的同时，每天上午进行主观纯音测听，观察听力变化情况，结果声信息组最少一个杨辛点听力提高≥15dB的占92％，其中86％是在3～5次治疗中产生的，而对照组听力点提高的病例仅占18％。为了证实两级疗效之差异，对无效病例采用交叉实验的…     

言语识别率测试在地中海贫血患者早期听损伤中的应用

目的探讨言语识别率测试时于监测地中海贫血患者治疗中早期听损伤的临床意义。方法对2013年9月至2014年11月在我院接受治疗的38例(76耳)地中海贫血患者进行纯音测听(常规频率+扩展高频)及言语识别率测试,观察治疗前后的听力改变情况。结果 38例(76耳)地中海贫血患者治疗前后的纯音听阈分别为(17.9±12.2)d BHL和(18.2±13.4)d BHL,言语识别率分别为(93.6±5.9)%和(91.5±8.0)%;治疗前后地贫患者的常频纯音听阈差异无统计学意义(P>0.05),而言语识别率较治疗前轻度下降,两者差异有统计学意义(P<0.05);治疗后的扩展高频阈值较治疗前有升高,以10k Hz、12.5 k Hz、18 k Hz、19 k Hz、20 k Hz最为显著,治疗前后差异有统计学意义(P<0.05)。结论言语识别率及扩展高频相互结合对地贫患者早期听损伤监测可能更有意义。     

迷路震荡致听力损害的临床探讨

目的 探讨轻度闭合性颅脑损伤造成的听力学变化特点,为临床诊断与法医学鉴定提供一定的理论依据.方法 在临床实践中,选取85例轻度闭合性颅脑损伤患者,经详细询问病史、耳科及神经系统全面检查、颞骨或头颅CT扫描,对纯音测听、声导抗、听性脑干反应及40 Hz听觉相关电位检查进行分析研究.结果 (1)轻度闭合性颅脑损伤后听力损害多为感音神经性耳聋,听力损失程度多≤60 dB,少数患者听力损失较重或为混合性聋,部分患者可伴耳鸣、眩晕、恶心或短暂呕吐等症状;(2)伤后不同时间的听力损失程度不一,各检查阈值与正常听力组比较均有明显差异(P<0.05),听力损失多在高频区;(3)ABR各波潜伏期、波间期与正常听力组比较,除Ⅰ-Ⅲ、Ⅰ-Ⅴ波间期差异不显著外(P>0.05),其余差异均有显著性(P<0.05).结论 (1)轻度闭合性颅脑损伤可引起内耳迷路震荡,造成一定程度的高频听力损害和轻微脑干损伤,部分患者伴有前庭功能障碍:在评估或鉴定外伤后听力损伤程度时,还应考虑到伤后不同时期听力变化规律,合理把握鉴定时间,最终做出客观合理的临床诊断或法医学鉴定.(2)ABR与40 Hz听觉相关电位检查联合使用,可以互相弥补听力检查中的不足.为临床诊断与法医学鉴定提供一定的理论依据.     

小剂量庆大霉素鼓室内注射治疗难治性梅尼埃病对听力影响的研究

目的　明确小剂量庆大霉素鼓室内注射治疗难治性梅尼埃病眩晕对听力的影响。方法　回顾分析60例单侧难治性梅尼埃病患者显微镜下小剂量鼓室内注射庆大霉 素,记录注射前后言语频率、4和8 kHz听阈变化。结果  60例患者中言语频率、4和8 kHz听阈,注射前分别为（61.92±2.03）dB、（68.00±2.69）dB、（75.73±2.86）dB,注射后分别为（57.41±2.01）dB、（65.11±2.87）dB、（72.51±3.18）dB,无统计学意义（P＞0.05）;庆大霉素鼓室内注射治疗后在言语听阈、4和8 kHz听阈提高≥15 dB患者分别有4、5、4例;听力下降率分别为6.67%、8.33%,6.67%,而注射后言语听阈、4和8 kHz听阈降低≥15 dB患者分别有8、8、8例,听力改善率为13.33%;余者听力注射前后听阈变化在10 dB之内。结论　小剂量庆大霉素鼓室内注射治疗难治性梅尼埃病眩晕安全有效,对听力无明显影响。     

经鼓室微导管持续泵入庆大霉素治疗难治性梅尼埃病

目的 观察经鼓室内微导管持续泵入庆大霉素治疗单侧难治性梅尼埃病的疗效。方法 对21例单侧难治性梅尼埃病患者经耳后进路鼓室内插入微导管，在2天内用微量泵以0．1ml／h的速度注入庆大霉素0．048g，然后观察眩晕、听力及耳鸣的变化。结果 21例平均随访23个月，眩晕完全控制18例，明显减轻3例，其中有2例复发再次治疗后眩晕消失；听力无明显改变有15例，听力平均下降5．1～7．6dB的有5例，听力平均下降10．4dB以上者1例；耳鸣消失者9例，明显减轻者6例，不变者6例。结论 经鼓室微导管持续泵入庆大霉素治疗难治性梅尼埃病，可有效地控制眩晕，改善耳鸣；对听力的损害较轻微，可作为单侧难治性梅尼埃病的首选治疗方法。     

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.     

Preoperative vestibular ablation with gentamicin and vestibular 'prehab' enhance postoperative recovery after surgery for pontine angle tumours--first report

CONCLUSIONS: Preoperative gentamicin in combination with vestibular 'prehab' offers a possibility to reduce postoperative malaise and speed up recovery and may be used for patients undergoing such surgery when there is remaining vestibular function. OBJECTIVES: Removal of pontine angle tumours in a patient with remaining vestibular function causes symptoms of acute vestibular loss. A simultaneous cerebellar lesion can cause a combined vestibule-cerebellar lesion. PATIENTS AND METHODS: Twelve patients with pontine angle tumours but with near normal vestibular function were treated with intratympanic gentamicin in combination with vestibular 'prehab' to achieve preoperative vestibular ablation and compensation. After work-up patients started with a home-based vestibular training programme for 14 days. They then received a total of 1.2 ml of 30 mg/ml buffered gentamicin in four intratympanic installations over 2 days. They continued training and returned 6-16 weeks later. All patients were tested with calorics, vestibular video-impulse testing of all six canals, VEMP, subjective visual vertical and horizontal, posturography and pure tone and speech audiometry. RESULTS: There was a loss of caloric reactions and loss of impulses. In two patients the hearing deteriorated and in one hearing improved. All subjects were vestibulary compensated before surgery and no patient complained of dizziness or vertigo after surgery.     

Ménière's disease in childhood.

We report 3 rare cases of Ménière's disease in children. In Case 1 and 3, vertigo, hearing loss and tinnitus recovered soon after medical therapy. In Case 2, however, vertigo recurred and the hearing level on the right side markedly deteriorated. The equal-loudness contours on three-dimensional audiogram showed that right-sided aggravated hearing loss fluctuated for 4 years at middle-and low-frequencies despite medication. Finally intratympanic injection of gentamicin sulfate was performed. The patient has had no definitive spell of vertigo after gentamicin therapy. At our department, the incidence of Ménière's disease in pediatric patients with vertigo was 2.9%.     

Hearing loss following intratympanic instillation of gentamicin for the treatment of unilateral Meniere's disease

OBJECTIVE: To determine the incidence, extent, and time course of hearing loss following instillation of intratympanic gentamicin using a predetermined fixed protocol for incapacitating unilateral Meniere's disease and to determine whether such loss is associated with any identifiable risk factors. STUDY DESIGN: A retrospective analysis of all patients treated with intratympanic gentamicin between 1988 and 1998 using American Academy of Otolaryngology-Head and Neck Surgery reporting guidelines (1985 and 1995). A predetermined regimen using a fixed dose (gentamicin 26.7 mg/mL administered three times daily for 4 consecutive days) was used. METHODS: The records of patients treated with this particular protocol were reviewed. The relationship between pretreatment hearing acuity, pretreatment bithermal caloric response, duration of symptoms, and previous treatment to post-treatment hearing were analyzed with respect to hearing. RESULTS: Complete vestibular and audiologic data over a minimum 2-year follow-up were available for 85 individuals. Sixty-three patients (74.1%) had unchanged or improved hearing, and 22 patients (25.9%) realized hearing loss. In 80% of the latter, it occurred during the first month post-treatment. When hearing acuity at the 1-month post-treatment interval remained unchanged (91.1%), it was likely to remain so over the next 23 months. A significantly higher incidence of profound hearing loss was noted in patients who developed hearing loss in the first month, as compared with those who developed hearing loss at a later period (p = .0207, relative risk = 1.5). Re-treatment was not associated with hearing loss. The only identifiable risk factor for developing hearing loss was pretreatment hearing acuity stages 3 and 4 (pure-tone average > 40 dB) (p = .022, relative risk = 1.5). CONCLUSION: Hearing loss is a recognized complication of treatment with intratympanic gentamicin, occurring in approximately 26% of individuals. In those individuals in whom hearing acuity has remained unchanged after the first month interval, significant worsening of hearing is unlikely, and patients can be reassured accordingly.     

Intratympanic gentamicin for unilateral Menière's disease: results of therapy

Intratympanic gentamicin for unilateral Menière's disease: results of therapy Patients with Menière's disease that remains refractory to conservative treatment have traditionally been subjected to ablative surgery. The purpose of this prospective study was to evaluate the use of intratympanic gentamicin in eliminating incapacitating vertigo, while preserving hearing. Over the past 8 years, 83 patients have received between 1 and 6 intratympanic injections of gentamicin in an out‐patient setting, with duration of therapy titrated to individual symptom response and effect on hearing. Using established AAO‐HNS guidelines, we present data on 50 patients who have a minimum of 2 years follow‐up. Control or significant improvement of definitive Menière's attacks was achieved in 92% of patients and hearing preserved or improved in 76%. Only one patient experienced profound sensorineural hearing loss. We feel this treatment option should be considered and offered to patients in whom medical treatment has failed.     

Use of the Round Window Microcatheter in the Treatment of Meniere's Disease

Objectives/Hypothesis Transtympanic gentamicin is an increasingly popular treatment for Meniere's disease. The present report examines the 2‐year follow‐up of our first 27 patients with Meniere's disease treated with the use of microdose gentamicin through the Round Window Microcatheter. We applied the 1995 American Academy of Otolaryngology—Head and Neck Surgery criteria to this patient group to analyze the results of treatment. Study Design This study is an evaluation of consecutive patients with predetermined data collection on each patient. Methods Patients with confirmed Meniere's disease underwent placement of the Round Window Microcatheter, which was filled with 10 mg/mL gentamicin, after placement into the round window niche was confirmed. Ten milligrams per milliliter of gentamicin was injected into the catheter by hand on two occasions after device placement in the first several patients. The remaining patients had continuous infusion of 10 mg/mL gentamicin at 1μL/h for the next 10 days. The catheter was removed 10 days after placement. All patients underwent an extensive set of hearing and vestibular tests on several occasions before, during, and after treatment. Results In the patients in the study, vertigo was eliminated in 92.6%, with 3.7% of patients (1/27) demonstrating a mild permanent threshold shift in hearing. Tinnitus and pressure were significantly reduced in more than 65% of patients. Only one patient demonstrated a reduction of vestibular function after treatment. Conclusions Results of this study on this group of patients indicate that vertigo can be controlled in the long term using microdose gentamicin without a significant reduction in cochlear or vestibular function in most of the patients in our series. Our results are compared with the published literature examining transtympanic injection. In addition, the underlying science supporting this type of treatment is examined.     

Systemic absorption of gentamicin nasal irrigations

OBJECTIVE: To determine if gentamicin nasal irrigation is systemically absorbed, and to identify any ototoxic side effects related to its use. DESIGN: Retrospective review of 12 patients treated with gentamicin nasal irrigations (30 cc of 80 mg/L solution used bilaterally twice daily). METHODS: Serum gentamicin levels were assayed after the course treatment. Pure tone audiometry (250-8000 Hz) and distortion product otoacoustic emissions (DP-OAEs) at 7280, 5133, 3640 and 2560 Hz were obtained before and after therapy. RESULTS: Twelve patients (age 4 to 74, mean 43) with chronic rhinosinusitis were treated for 3-15 weeks (mean 7 weeks). All patients had undergone previous endoscopic sinus surgery. Ten patients had pretreatment cultures that grew organisms sensitive to gentamicin (Pseudomonas, Proteus, or methacillin resistant Staphylococcus aureus), and three patients had cystic fibrosis. Ten of 12 patients (83%) had detectable posttreatment levels of gentamicin, with a mean serum level of 0.42 mcg/mL (range 0.3 to 0.7 mcg/mL). Four of 12 patients (33%) had serum gentamicin levels within the normal range for gentamicin trough (0.5 to 2 mcg/mL). Comparison of pre- and posttreatment audiologic data revealed no significant change in PTA or DP-OAE, except for the right ear at 8000 Hz on PTA (p = 0.035) where a mean of 7 dB loss was observed. No patient reported hearing loss or vertigo during treatment. CONCLUSION: Gentamicin nasal irrigation may be systemically absorbed. Although the otologic consequences of this finding are questionable, patients receiving gentamicin nasal irrigations should be counseled regarding this hypothetical possibility.     

Long-term hearing outcome in patients receiving intratympanic gentamicin for Ménière's disease

OBJECTIVE: To determine the long-term hearing outcome in patients with intractable vertigo caused by unilateral Ménière's disease who were treated with intratympanic injection of gentamicin. STUDY DESIGN: The study was a longitudinal analysis of hearing and control of vertigo in patients with unilateral Ménière's disease who received intratympanic gentamicin. METHODS: Pure-tone thresholds and speech discrimination scores on audiometry were analyzed, along with the control of vertigo. Criteria described in 1995 by the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) were used. Patients treated with intratympanic gentamicin had "definite" Ménière's disease and had intractable vertigo despite optimal medical therapy, no symptoms suggestive of Ménière's disease in the contralateral ear, and serviceable hearing in the contralateral ear. The study analyzed the outcomes of 34 patients for whom follow-up data were available for periods greater than 24 months after intratympanic gentamicin. RESULTS: Complete control of vertigo (AAOHNS Class A) was obtained in 90% of the patients. Profound sensorineural hearing loss occurred as a result of gentamicin injection in 1 of the 34 patients (3%). When data from all patients were grouped together, hearing was improved in 5 (15%), unchanged in 23 (68%), and worse in 6 (17%) patients. This distribution of hearing outcome is similar to that in patients whose symptoms of Ménière's disease were managed with medical measures. Recurrent vertigo developed in 10 patients (29%) at an interval of 4 to 15 months after initially complete control. Treatment with additional intratympanic injection(s) of gentamicin did not result in a change in hearing. CONCLUSION: The risk of hearing loss in patients treated with infrequent intratympanic injection(s) of gentamicin is low.