Drop attacks

And another interesting one (basically, after gentamicin not working well enough, going onto labyrinthectomy - "Vertigo was controlled (class A) in all the patients who received labyrinthectomies (n = 4) or vestibular neurectomy (n = 1)":

Laryngoscope. 2015 Apr;125(4):972-8. doi: 10.1002/lary.25009. Epub 2014 Nov 1.
Management of intractable Ménière's disease after intratympanic injection of gentamicin.
Rah YC1, Han JJ, Park J, Choi BY, Koo JW.
Author information
1
Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea.
Abstract
OBJECTIVES/HYPOTHESIS:
1) To evaluate the efficacy of, and problems with, intratympanic gentamicin injection (ITG) in medically intractable definite Ménière's disease (MD) and secondary endolymphatic hydrops (EH); and 2) to review the vestibular status and treatment options of intractable vertigo even after ITG.

STUDY DESIGN:
Retrospective case review and survey.

METHODS:
780 patients with definite MD and secondary EH were enrolled. Long-term outcomes and problems of applied treatment options including ITG and exploratory tympanotomy and gentamicin application (ETG) were analyzed.

RESULTS:
Of the 780 patients, 95 patients received ITG. Class A and B control of vertigo was achieved in 85 (89.5%) patients; two patients were class C and eight patients were class F (ETG: 6; labyrinthectomy: 1; vestibular neurectomy: 1). Among seven patients who received ETG including 1 patient who skipped ITG due to chronic otitis media, five patients improved to class A, showing a 71.4% success rate; and labyrinthectomies were performed subsequently in the two remaining patients. Vertigo was controlled (class A) in all the patients who received labyrinthectomies (n = 4) or vestibular neurectomy (n = 1). Eight patients (8.4%) experienced more than 10 dB worsening, and two patients (2.1%) progressed to bilateral Ménière's disease.

CONCLUSION:
ITG failed to control vertigo in 10.5% of cases. ETG may be a reasonable option to facilitate the delivery of gentamicin into the inner ear by direct application of gentamicin over the round window and the oval window. Labyrinthectomy and vestibular neurectomy still have roles in the era of ITG.

© 2014 The American Laryngological, Rhinological and Otological Society, Inc.

 

Really useful stuff, Anne. This is the kind of information I was looking for a year ago when deciding between gent and laby. Thanks for sharing.