Abstract：
OBJECTIVE: Meniere\'s disease (MD), a disorder of the inner ear, presents numerous therapeutic challenges, and intratympanic (IT) gentamicin has been proposed for intractable cases. However, controversy regarding dosage and method persists. The purpose of this study was to assess the efficacy and safety of low-dose IT gentamicin on vertigo attacks in MD using a clinical symptomatology-based method, wherein administration was repeated only if vertigo attacks recurred, with a 2-week interval between injections.
METHODS: This study included 88 patients with unilateral intractable MD. All patients received one to five IT injections with 0.5 ml of 10 mg of gentamicin (80 mg/2 ml) with an interval of 2 weeks between injections. Vertigo attacks were evaluated before and after therapy and categorized into classes A-F according to the 2015 Equilibrium Committee criteria. Audiovestibular assessments, including Pure Tone Audiometry and Vestibulo-Ocular Reflex evaluations, were performed.
RESULTS: Before treatment, patients had an average of 4.4 vertigo attacks/month; after treatment, this average decreased to 0.52. The majority of patients (57 %) reached Class A or B vertigo control with five or fewer gentamicin injections. VOR gain was slightly affected on the healthy side and significantly reduced on the affected side. No hearing deterioration was found in any of the treated patients.
CONCLUSIONS: Low-dose IT gentamicin administration based on clinical symptomatology can produce a satisfactory control of vertigo attacks after treatment. This protocol primarily affected the vestibular function, as demonstrated by the significant reduction in VOR gain on the affected side, while avoiding cochlear damage. The lack of adverse events and preservation of hearing underscore the safety and efficacy of this method. These findings have significant clinical implications, suggesting that a low-dose, clinical symptomatology-based gentamicin treatment regimen could be an effective and safe strategy for managing unilateral Meniere\'s disease in a larger population.
METHODS: This study included 88 patients with unilateral intractable MD. All patients received one to five IT injections with 0.5 ml of 10 mg of gentamicin (80 mg/2 ml) with an interval of 2 weeks between injections. Vertigo attacks were evaluated before and after therapy and categorized into classes A-F according to the 2015 Equilibrium Committee criteria. Audiovestibular assessments, including Pure Tone Audiometry and Vestibulo-Ocular Reflex evaluations, were performed.
RESULTS: Before treatment, patients had an average of 4.4 vertigo attacks/month; after treatment, this average decreased to 0.52. The majority of patients (57 %) reached Class A or B vertigo control with five or fewer gentamicin injections. VOR gain was slightly affected on the healthy side and significantly reduced on the affected side. No hearing deterioration was found in any of the treated patients.
CONCLUSIONS: Low-dose IT gentamicin administration based on clinical symptomatology can produce a satisfactory control of vertigo attacks after treatment. This protocol primarily affected the vestibular function, as demonstrated by the significant reduction in VOR gain on the affected side, while avoiding cochlear damage. The lack of adverse events and preservation of hearing underscore the safety and efficacy of this method. These findings have significant clinical implications, suggesting that a low-dose, clinical symptomatology-based gentamicin treatment regimen could be an effective and safe strategy for managing unilateral Meniere\'s disease in a larger population.
摘要：
目标：梅尼埃病（MD），内耳的紊乱，提出了许多治疗挑战，鼓室内（IT）庆大霉素已被建议用于难治性病例。然而,关于剂量和方法的争议仍然存在。这项研究的目的是使用基于临床症状学的方法评估低剂量IT庆大霉素对MD眩晕发作的疗效和安全性。其中仅在眩晕发作复发时重复给药，注射间隔2周。
方法：本研究纳入88例单侧难治性MD患者。所有患者均接受1至5次IT注射，其中0.5ml10mg庆大霉素（80mg/2ml），两次注射间隔为2周。在治疗前后对眩晕发作进行评估，并根据2015年平衡委员会标准将其分为A-F类。前庭听觉评估，包括纯音测听法和前庭眼反射评估，被执行了。
结果：治疗前，患者平均有4.4眩晕发作/月；治疗后，这一平均值下降到0.52。大多数患者（57％）通过五次或更少的庆大霉素注射达到A类或B类眩晕控制。VOR增益在健康侧受到轻微影响，在受影响侧明显减少。在任何接受治疗的患者中均未发现听力恶化。
结论：根据临床症状给予小剂量庆大霉素治疗可对治疗后的眩晕发作产生满意的控制。这个方案主要影响前庭功能，如受影响侧VOR增益显着降低所示，同时避免耳蜗损伤。缺乏不良事件和听力的保留强调了该方法的安全性和有效性。这些发现具有重要的临床意义，表明低剂量，基于临床症状学的庆大霉素治疗方案可能是治疗更大人群中单侧梅尼埃病的有效和安全的策略.
方法：本研究纳入88例单侧难治性MD患者。所有患者均接受1至5次IT注射，其中0.5ml10mg庆大霉素（80mg/2ml），两次注射间隔为2周。在治疗前后对眩晕发作进行评估，并根据2015年平衡委员会标准将其分为A-F类。前庭听觉评估，包括纯音测听法和前庭眼反射评估，被执行了。
结果：治疗前，患者平均有4.4眩晕发作/月；治疗后，这一平均值下降到0.52。大多数患者（57％）通过五次或更少的庆大霉素注射达到A类或B类眩晕控制。VOR增益在健康侧受到轻微影响，在受影响侧明显减少。在任何接受治疗的患者中均未发现听力恶化。
结论：根据临床症状给予小剂量庆大霉素治疗可对治疗后的眩晕发作产生满意的控制。这个方案主要影响前庭功能，如受影响侧VOR增益显着降低所示，同时避免耳蜗损伤。缺乏不良事件和听力的保留强调了该方法的安全性和有效性。这些发现具有重要的临床意义，表明低剂量，基于临床症状学的庆大霉素治疗方案可能是治疗更大人群中单侧梅尼埃病的有效和安全的策略.
