RESUMO
OBJECTIVE: Assess the relative efficacy and results of the round window hyaluronic acid pledget depot method for intratympanic gentamicin delivery in Ménière's disease. STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral hospital. PATIENTS: Prospective symptomatic and audiologic data were collected on 28 patients undergoing intratympanic gentamicin therapy for Ménière's disease refractory to medical treatment between 2003 and 2009. INTERVENTION: All patients had the round window membrane exposed via a tympanomeatal flap, and any adhesions were removed. Hyaluronic acid pledgets soaked in 40 mg/ml of gentamicin were then packed into the round window niche and posterior mesotympanum, and the tympanomeatal flap was replaced. MAIN OUTCOME MEASURES: Patients audiologic and vertigo symptom outcome scores were recorded at follow-up according to the AAO-HNS 1995 guidelines for reporting results in Ménière's disease. RESULTS: Complete or substantial improvement in vertigo (class A or B) was achieved in 88.5% (23/26) of patients. Hearing loss, defined as greater than 10 dB (PTA average at 0.5, 1, 2, and 4 kHz) was noted in 12 (50%) of 24 patients including 4 patients who had developed "dead ears" (16%). The average hearing loss for all patients excluding the 4 patients with dead ears was 10.7 dB. CONCLUSION: Round window hyaluronic acid pledget technique used as a sustained delivery vehicle for intratympanic gentamicin treatment for Ménière's disease produces similar rates of vertigo control compared with other techniques but a greater risk of hearing loss. We would recommend the intratympanicinjection titration technique as first line for most patients.
Assuntos
Antibacterianos/uso terapêutico , Orelha Média/efeitos dos fármacos , Gentamicinas/uso terapêutico , Perda Auditiva/tratamento farmacológico , Doença de Meniere/tratamento farmacológico , Antibacterianos/administração & dosagem , Sistemas de Liberação de Medicamentos , Feminino , Gentamicinas/administração & dosagem , Perda Auditiva/diagnóstico , Humanos , Masculino , Doença de Meniere/diagnóstico , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do TratamentoRESUMO
We present a case of a highly unusual stapes in the presence of a normal external ear. The stapes exhibits rudimentary anterior crus with abnormally shaped posterior crus that attached to the mid-portion of a fixed, rudimentary footplate. To our knowledge, this anomaly has not been previously documented. We review the embryological cause that may be contributing to the development of this congenitally abnormal stapes superstructure. This is to highlight the importance of the knowledge of the anatomy of the stapes and its variations especially to the otologists.
