Evidence-based modification of intratympanic gentamicin injections in patients with intractable vertigo.
Evidence-based modification of intratympanic gentamicin injections in patients with intractable vertigo.
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DOI：
10.1097/mao.0b013e3181dbb30e
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发表时间：
2010-06
期刊：
影响因子：
--
通讯作者：
Steyger PS
中科院分区：
文献类型：
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作者：
Zhai F;Liu JP;Dai CF;Wang Q;Steyger PS
比较豚鼠鼓室给药后低剂量荧光庆大霉素的耳蜗分布与顽固性眩晕患者使用低剂量鼓室给药庆大霉素的临床资料。将纯化庆大霉素-德克萨斯红（GTTR）经腹腔注射到大鼠耳蜗内，用共聚焦显微镜观察GTTR荧光在耳蜗外毛细胞（OHCs）内的分布和时间过程。GTTR迅速被OHCs吸收，特别是在表皮下区。GTTR在耳蜗内呈基底-耳尖递减梯度分布，并保留在OHCs内，直到注射后4周荧光均未明显减弱。鼓室内给药后，OHCs迅速吸收GTTR，清除缓慢。基于我们的动物数据，我们将改良的低剂量鼓室内滴入方法应用于顽固性m<s:1>尼康<e:1>病（MD）患者，并跟踪临床结果。MD患者改良鼓室内注射后，89%的患者眩晕得到控制，16%的患者听力下降。因此，3周间隔滴注技术具有较高的眩晕控制率和较低的听力损失风险，是其他鼓室内注射方案的可行替代方案。
To compare the cochlear distribution of low-dose fluorescent gentamicin after intra-tympanic administration in guinea pig (GPs) with clinical data of low dose intra-tympanic gentamicin in patients with intractable vertigo. Purified gentamicin-Texas Red (GTTR) was injected intratympanically into GPs and the cochlear distribution and time course of GTTR fluorescence in outer hair cells (OHCs) was determined using confocal microscopy. GTTR was rapidly taken up by OHCs, particularly in the subcuticular zone. GTTR was distributed in the cochlea in a decreasing baso-apical gradient, and was retained within OHCs without significant decrease in fluorescence until 4 weeks after injection. OHCs rapidly take up GTTR after intra-tympanic administration with slow clearance. A modified low-dose titration intratympanic approach was applied to patients with intractable Ménière’s Disease (MD) based on our animal data and the clinical outcome was followed. After the modified intratympanic injections for MD patients, vertigo control was achieved in 89% patients, with hearing deterioration identified in 16% patients. The 3-week interval titration injection technique thereby had a relatively high vertigo control rate with a low risk of hearing loss, and is a viable alternative to other intratympanic injection protocols.