메니에르병 환자의 치료경과 및 고실 내 겐타마이신 주입술에 대한 고찰
Treatment of Meniere’s Disease and Intratympanic Gentamicin Injection
3
조회
0
다운로드
3
인용
0
참고문헌
키워드
초록
Background and Objectives Several treatment options have been introduced to control Meniere’s disease (MD). Among them, intratympanic injection of gentamicin (ITGM) is now accepted as a standard treatment method for intractable vertigo in patients with hearing impaired MD. The purpose of this study was to analyze the clinical course and treatment flow in patients with MD and to analyze the efficacy and problems after ITGM. Subjects and Method A retrospective study was performed on 458 patients who were diagnosed as definite MD from May 2003 to October 2007 and were followed up at least 1 year. The authors investigated the course of disease and the results in our patients according to the treatment options. Several clinical parameters including frequency of vertigo, audiometry, caloric and rotation test were reviewed and analyzed according to the guideline of the AAO-HNS (1995), if necessary. Efficacy and problems after ITGM were reviewed. Results Among 458 patients, vertigo was resolved or improved in 399 patients (87.1%) with medical management. Fifty-nine patients needed further treatment (endolymphatic sac decompression: 4, Meniette: 2, ITGM: 53). Among 53 patients who got ITGM, 40 patients were followed up for more than 1 year after injection. Thirty-six patients (87.5%) showed successful control of vertigo. The average pure-tone threshold was changed from 54.1 dB to 56.9 dB after treatment. Three patients (7.5%) revealed more than 20 dB aggravation. Conclusion Vertigo was controlled by supportive treatments or medication in 87% of definite MD patients. And ITGM could effectively and reasonably control vertigo for intractable MD patients.
Abstract
Background and Objectives Several treatment options have been introduced to control Meniere’s disease (MD). Among them, intratympanic injection of gentamicin (ITGM) is now accepted as a standard treatment method for intractable vertigo in patients with hearing impaired MD. The purpose of this study was to analyze the clinical course and treatment flow in patients with MD and to analyze the efficacy and problems after ITGM. Subjects and Method A retrospective study was performed on 458 patients who were diagnosed as definite MD from May 2003 to October 2007 and were followed up at least 1 year. The authors investigated the course of disease and the results in our patients according to the treatment options. Several clinical parameters including frequency of vertigo, audiometry, caloric and rotation test were reviewed and analyzed according to the guideline of the AAO-HNS (1995), if necessary. Efficacy and problems after ITGM were reviewed. Results Among 458 patients, vertigo was resolved or improved in 399 patients (87.1%) with medical management. Fifty-nine patients needed further treatment (endolymphatic sac decompression: 4, Meniette: 2, ITGM: 53). Among 53 patients who got ITGM, 40 patients were followed up for more than 1 year after injection. Thirty-six patients (87.5%) showed successful control of vertigo. The average pure-tone threshold was changed from 54.1 dB to 56.9 dB after treatment. Three patients (7.5%) revealed more than 20 dB aggravation. Conclusion Vertigo was controlled by supportive treatments or medication in 87% of definite MD patients. And ITGM could effectively and reasonably control vertigo for intractable MD patients.
참고문헌 (20)
- Blakley BW, "Update on intratympanic gentamicin for Meniere’s disease", Laryngoscope, 110(2), pp.236~240 (2000)
- Cohen-Kerem R, "Intratympanic gentamicin for Meniere’s disease: a meta-analysis", Laryngoscope, 114(12), pp.2085~2091 (2004)
- Chia SH, "Intratympanic gentamicin therapy for Meniére’s disease: a meta-analysis", Otol Neurotol, 25(4), pp.544~552 (2004)
- Smith BM, "The penetration of gentamicin and neomycin into perilymph across the round window membrane", Otolaryngol Head Neck Surg, 87(6), pp.888~891 (1979)
- Hibi T, "Perilymphatic concentration of gentamicin administered intratympanically in guinea pigs", Acta Otolaryngol, 121(3), pp.336~341 (2001)
- Park JC, "Vestibular ototoxicity in the chick: effects of streptomycin on equilibrium and on ampullary dark cells", Am J Otolaryngol, 3(2), pp.117~127 (1982)
- Toth AA, "Intratympanic gentamicin therapy for Meniére’s disease: preliminary comparison of two regimens", J Otolaryngol, 24(6), pp.340~344 (1995)
- Inoue H, "Low-dose intratympanic gentamicin treatment of Meniére’s disease", Eur Arch Otorhinolaryngol, 251(1), pp.12~14 (1994)
- Driscoll CL, "Lowdose intratympanic gentamicin and the treatment of Meniére’s disease: preliminary results", Laryngoscope, 107(1), pp.83~89 (1997)
- 정원호, "메니에르 질환에서 단일 주입법을 이용한 고실 내 겐타마이신 주입술의 치료 효과", 대한이비인후과학회지 두경부외과학, 47(10), pp.950~956 (2004), 대한이비인후과학회
- "Committee on Hearing and Equilibrium guidelines for the diagnosis and evaluation of therapy in Meniére’s disease", Otolaryngol Head Neck Surg, 113(3), pp.181~185 (1995), American Academy of Otolaryngology-Head and Neck Foundation
- Schuknecht HF, "Delayed endolymphatic hydrops", Ann Otol Rhinol Laryngol, 87(6), pp.743~748 (1978)
- Schuknecht HF, "Delayed endolymphatic hydrops and its relationship to Meniére’s disease", Ann Otol Rhinol Laryngol, 99(11), pp.843~853 (1990)
- Pearson BW, "Committee on Hearing and Equilibrium guidelines for reporting treatment results in Meniere’s disease", Otolaryngol Head Neck Surg, 93(5), pp.579~581 (1985)
- Torok N, "Old and new in Ménière disease", Laryngoscope, 87(11), pp.1870~1877 (1977)
- Diamond C, "Systematic review of intratympanic gentamicin in Meniere’s disease", J Otolaryngol, 32(6), pp.351~361 (2003)
- Tran Ba Huy P, "Comparison of inner ear tissues and fluids with other organs", J Clin Invest, 77(5), pp.1492~1500 (1986)
- Minor LB, "Intratympanic gentamicin for control of vertigo in Meniere’s disease: vestibular signs that specify completion of therapy", Am J Otol, 20(2), pp.209~219 (1999)
- Carey J, "Intratympanic gentamicin for the treatment of Meniere’s disease and other forms of peripheral vertigo", Otolaryngol Clin North Am, 37(5), pp.1075~1090 (2004)
- Qvortrup K, "The endolymphatic sac, a potential endocrine gland?", Acta Otolaryngol, 119(2), pp.194~199 (1999)