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Keywords:

  • Meniere's;
  • streptomycin;
  • gentamicin;
  • aminoglycoside;
  • perfusion

Abstract

Objectives/Hypothesis:

To evaluate the hearing changes and quality-of-life outcomes of 393 cases of streptomycin/dexamethasone inner ear perfusion performed by the primary author on 312 ears of 299 patients with Meniere's disease between July 2002 and May 2010.

Study Design:

Retrospective chart review.

Methods:

Objective arm: A database was used to compile pretreatment and post-treatment audiograms as well as basic demographic information, dates of treatment, number of treatments, and which ear was treated. All patients met the 1995 American Academy of Otolaryngology–Head and Neck Surgery Committee on Hearing and Equilibrium Guidelines for the diagnosis and evaluation of therapy in Meniere's disease. All patients underwent one or more 3-day treatments consisting of daily intratympanic injections of a low-dose streptomycin/high-dose dexamethasone mixture plus intravenous dexamethasone. The end point for treatment was adequate control of vertigo. Subjective arm: The Meniere's Disease Outcomes Questionnaire survey was used to assess patients' quality of life after receiving streptomycin/dexamethasone inner ear perfusion. All procedures were performed by the primary author at the Shea Ear Clinic, a tertiary-referral otology clinic and outpatient surgery center.

Results:

After a single 3-day treatment, the average change in pure tone average was 0.89 dB (±11). The average change in word recognition score was 0.49% (±17). The average number of days from treatment to follow-up audiogram was 94 with a range of 8 to 1,603. Clinically significant hearing loss occurred after 62 of 393 (15.7%) treatments. Severe hearing loss occurred after 20 of 393 treatments (5.0%). The percentage of ears with clinically significant hearing loss after all treatments was 56 of 312 (17.9%). A total of 215 surveys were returned from 383 patients (56.1%) to whom they were mailed. There were 90% of patients who indicated improvement in quality of life after treatment and 88% who indicated improvement in their “vertigo subscore,” a domain within the survey that focuses on vertigo control.

Conclusions:

Streptomycin/dexamethasone inner ear perfusion is as safe to the hearing of patients with Meniere's disease as other aminoglycoside regimens and provides a significant improvement in quality of life.Laryngoscope, 122:204–211, 2012