Single-shot, low-dose intratympanic gentamicin in Ménière disease: role of vestibular-evoked myogenic potentials and caloric test in the prediction of outcome.

OBJECTIVE: The aim of this study was to assess the efficacy and safety of single and low-dose intratympanic gentamicin therapy in patients with Ménière disease and who were monitored both with caloric tests and vestibular-evoked myogenic potentials (VEMPs) to see if VEMPs have an additional role in predicting the efficacy of the drug. STUDY DESIGN: This is a prospective cohort study. SETTING: Tertiary referral center is the study setting. PATIENTS: Twenty-five intractable Ménière disease patients were included as the study group. INTERVENTION(S): Low-dose (16 mg/mL), single-shot intratympanic gentamicin was applied. VEMP and caloric test were applied 2 weeks after the application. MAIN OUTCOME MEASURE(S): Safety and efficacy of protocol were evaluated at the sixth month postoperatively with tonal audiogram and visual analog scale, respectively. RESULTS: Mean average pure-tone hearing threshold at 0.5, 1, 2, 4, and 8 kHz was 49.6 and 51.0 dB before and after the application, respectively (P > .05). Mean pretreatment and posttreatment visual analog scale scores of patients were 17.6 mm (10-30 mm) and 74.6 mm (41-100 mm), respectively (P < .01). Posttreatment VEMPs were absent in 17, deteriorated in 2, and not changed in 6 patients. VEMP was a significant predictor of posttreatment visual analog scale score, whereas caloric test was not (P < .01). CONCLUSIONS: Low-dose, single-shot intratympanic gentamicin treatment proved to be effective and safe among intractable Ménière patients. VEMPs obtained at posttreatment second week were significant predictors of patients posttreatment sixth-month dizziness status and vertigo control.

Does betahistine treatment have additional benefits to vestibular rehabilitation?

The aim of this study was to investigate the effect of high-dose betahistine treatment added to vestibular rehabilitation (VR) on the disability, balance and postural stability in patients with unilateral vestibular disorder. The VR group (group 1, n = 24) and the VR + betahistine group (group 2, n = 23) were analyzed retrospectively. All patients were evaluated before and after an 8-week customized VR in terms of disability (Dizziness Handicap Inventory, DHI), dynamic balance [Dynamic Gait Index (DGI)] and postural stability (static posturography). In group 1 and group 2, differences between DHI, DGI and falling index score on static posturography before and after the exercise program were significant (p < 0.05). In addition, a significant difference was detected only in group 2 in the variables evaluated in static posturography-Fourier 4 analysis (p < 0.05). Both VR and betahistine + VR have a positive effect on disability and balance in patients with unilateral vestibular disorder. Betahistine treatment added to VR was effective in increasing postural stability.

Clinical assessment of topiramate therapy in patients with migrainous vertigo.

OBJECTIVE: To assess the efficacy of topiramate in reducing both the frequency and the severity of vertigo and headache attacks in patients with migrainous vertigo and to compare 50 and 100 mg/day doses of the drug. METHODS: Thirty patients diagnosed as definite migrainous vertigo were recruited in the study. Vertigo and headache frequency was determined as the monthly number of attacks whereas severity was determined by visual analog scales measured in millimeters from 0 to 100. Patients were randomized to either 50 or 100 mg/day topiramate for 6 months. Vertigo and headache frequency and severity were evaluated at the end of the study period. RESULTS: Number of mothly vertigo attacks decreased significantly in the overall group after treatment (median from 5.5 to 1; P < .01). The same was true for monthly headache attacks (median from 4 to 1; P < .01). A statically significant improvement in vertigo severity was noted (median from 80 to 20 mm; P < .01). Headache severity showed significant improvement as well (median from 60 to 30 mm; P < .01). No statistically significant difference between high- and low-dose groups was present regarding efficacy (P > .05). Four patients in the high-dose group discontinued treatment at the end of the first month because of adverse effects. CONCLUSIONS: In the overall group, topiramate was found to be effective in reducing the frequency and the severity of vertigo and headache attacks. Both doses of the drug were equally efficacious. The 50 mg/day dose seems to be appropriate as higher adverse effects were noted when 100 mg/day was used.