Intratympanic Treatment of Intractable Unilateral Meniere Disease: Gentamicin or Dexamethasone? A Randomized Controlled Trial
Intratympanic Treatment of Intractable Unilateral Meniere Disease: Gentamicin or Dexamethasone? A Randomized Controlled Trial
复制标题
DOI：
10.1177/0194599811429432
复制
发表时间：
2012-03-01
影响因子：
3.4
通讯作者：
Dallan, Iacopo
中科院分区：
文献类型：
--
作者：
Casani, Augusto Pietro;Piaggi, Paolo;Dallan, Iacopo
目标。目的：比较小剂量庆大霉素(ITG)鼓室内注射与地塞米松(ITD)鼓室注射治疗难治性单侧梅尼埃病(MD)的疗效和安全性。开放前瞻性随机对照研究。第三转诊中心。研究对象和方法。在2007年1月1日至2008年6月30日期间，纳入了60名明确的单侧MD患者。其中32例用庆大霉素缓冲溶液中耳注射(最多2次)，28例用ITD(4 mg/m L，3次/3d间隔注射)。平均结果测量包括眩晕发作的控制、纯音平均(PTA)、言语辨别分数、功能残疾分数，并使用重复测量方差分析进行统计分析。ITG组随访2年，眩晕完全控制26例(81%)，基本控制4例(12.5%)。在ITD组，12例(43%)患者达到A级，5例(18%)患者达到B级。在庆大霉素组中，4例患者的PTA下降了10分贝。ITD组16例(A~B级)PTA无变化或略有改善，12例PTA加重。在控制单侧MD患者眩晕发作方面，小剂量ITG取得了比ITD更好的效果，听力恶化的发生率非常低。ITD的眩晕控制率较低，只有在没有眩晕复发的情况下才能保持听力。
Objective. To determine the efficacy and safety of low-dose intratympanic gentamicin (ITG) compared with intratympanic dexamethasone (ITD) in patients with intractable unilateral Meniere disease (MD).Study Design. Open prospective randomized controlled study.Setting. Tertiary referral center.Subjects and Methods. Sixty patients affected by definite unilateral MD were enrolled between January 1, 2007, and June 30, 2008. Thirty-two patients were treated with a buffered gentamicin solution injected in the middle ear (maximum of 2 injections); 28 patients were treated with ITD (4 mg/mL, 3 injections at intervals of 1 every 3 days). Mean outcome measurements consisted of control of vertigo attacks, pure tone average (PTA), speech discrimination score, functional disability score, and statistical analysis using repeated measures analysis of variance.Results. In the ITG group at 2-year follow-up, complete control of vertigo (class A) was achieved in 26 patients (81%) and substantial control of vertigo (class B) in 4 patients (12.5%). In the ITD group, class A was achieved in 12 (43%), and class B in 5 (18%) patients. In the gentamicin group, 4 patients showed a reduction in PTA of >= 10 dB. In the ITD group, PTA was unchanged or slightly improved in 16 patients (belonging to class A-B) and worse in 12.Conclusions. Low-dose ITG achieved better outcome than ITD in the control of vertigo attacks in patients suffering from unilateral MD, with a very low incidence of hearing deterioration. ITD offers poorer vertigo control rate, and hearing preservation is achieved only in cases with no vertigo recurrences.