Long-term disability of class A patients with Ménière's disease after treatment with intratympanic gentamicin.

OBJECTIVE: The main objective of this study was to characterize the residual vestibular symptoms and disability in patients with Ménière's disease who had achieved complete control of vertigo through intratympanic gentamicin treatment. Furthermore, we assessed whether the Functional Level Score prior to treatment reflected the posttreatment symptoms and disability. STUDY DESIGN: Prospective. SETTING: Tertiary medical center. PATIENTS: This study involved 103 patients with Ménière's disease treated with intratympanic gentamicin who, after a long-term follow up, have not suffered new vertigo spells and were not subject to any major modification in their treatment. METHODS: At inclusion and at the last follow-up visit after a minimum of 3 years of ending the treatment, the clinical status (number of vertigo spells), the unsteadiness as well as the disability produced by the disease, symptoms of anxiety, and compensation were asked using specific questionnaires. The results before and after treatment were analyzed using nonparametric tests. RESULTS: After a 5-year follow-up, complete control of vertigo was obtained in 81% of the patients with Ménière's disease who were treated with intratympanic gentamicin. Of them, 15.5% still complained of unsteadiness. A functional level of 6 or unsteadiness after treatment are related with a nonreduction in disability after long-term control of vertigo spells. CONCLUSIONS: The efficacy of gentamicin administered intratympanically is high after long-term follow-up as shown by the disappearance of vertigo spells and by the reduction in disability, increase in perception of quality of life, and reduction in anxiety related to vestibular symptoms. Unsteadiness, although an infrequent complaint, determines a level of almost similar severity in those issues. Special care must be taken with patients with a Functional Level Scale score of 6 at the time of beginning treatment.

[Vestibular evoked myogenic potentials and benign paroxysmal positional vertigo]. / Resultados de los potenciales evocados miogénicos vestibulares en el vértigo posicional paroxístico benigno.

OBJECTIVE: Benign paroxysmal positional vertigo (BPPV) seems to occur because of otoconia migration into the semicircular canals or their adherence to the cupula. Although the origin of these otoconia lies in the macula of the utricle, vestibular evoked myogenic potentials (VEMPs) can be used assess saccular function. The aim of this study is to assess the saccular function in patients diagnosed with BPPV. PATIENTS AND METHOD: Nineteen patients diagnosed with BPPV of the posterior semicircular canal were included in this study. Their auditory function and their caloric, rotatory chair, and VEMP responses were tested. Ipsilateral and contralateral VEMP thresholds, ipsilateral and contralateral p13 and n23 latencies at 100 dB, inter-peak amplitude and the interaural amplitude difference were determined. RESULTS: We found a lack of VEMP response in 52 % of the ears with BPPV. When adjusted for bilateral absence, VEMP response was absent in 20.3 % of ears. CONCLUSIONS: Some patients with idiopathic BPPV show a degree of saccular dysfunction.

Caloric and rotatory chair test results in patients with Ménière's disease.

OBJECTIVES: To determine whether an association exists between the parameters of the caloric and rotatory chair tests in patients with unilateral Ménière's disease. METHODS: Patients with unilateral Ménière's disease (n = 100) were subjected to the caloric and the rotatory chair test (sinusoidal harmonic acceleration and impulsive tests) on the same day. Canal paresis and directional preponderance were assessed in the caloric test, and different variables were measured in the rotatory chair test based on the existence of abnormal parameters in the vestibulo-ocular reflex at two or three consecutive frequencies of those tested and on the time constant of the vestibulo-ocular reflex. STUDY DESIGN AND SETTING: A prospective study was conducted at a University hospital. RESULTS: An abnormal result in the caloric test was obtained from 73% of the patients. In the rotatory chair test, the most frequent abnormal findings involved increases in the normal phase lead at 2 consecutive frequencies tested (23%). There was a stronger association between an abnormal result in phase, gain, and/or symmetry at three adjacent frequencies and a pathological result in the caloric test. CONCLUSION: Very few of the criteria used to define the caloric and rotatory chair tests seem to be associated. This confirms previous knowledge that both tests examine vestibulo-ocular reflex by different ways. Only when vestibular dysfunction is severe enough (manifested by the finding of an abnormal result in at least three consecutive frequencies in the rotatory chair test), the caloric test is also found to be abnormal.

Intractable Ménière's disease. Modelling of the treatment by means of statistical analysis.

OBJECTIVE: To evaluate the value of different variables of the clinical history, auditory and vestibular tests and handicap measurements to define intractable or disabling Ménière's disease. METHODS: This is a prospective study with 212 patients of which 155 were treated with intratympanic gentamicin and considered to be suffering a medically intractable Ménière's disease. Age and sex adjustments were performed with the 11 variables selected. Discriminant analysis was performed either using the aforementioned variables or following the stepwise method. RESULTS: Different variables needed to be sex and/or age adjusted and both data were included in the discriminant function. Two different mathematical formulas were obtained and four models were analyzed. With the model selected, diagnostic accuracy is 77.7%, sensitivity is 94.9% and specificity is 52.8%. CONCLUSION: After discriminant analysis we found that the most informative variables were the number of vertigo spells, the speech discrimination score, the time constant of the VOR and a measure of handicap, the "dizziness index".

Resultados de los potenciales evocados miogénicos vestibulares en el vértigo posicional paroxístico benigno / Vestibular evoked myogenic potentials and benign paroxysmal positional vertigo

Objetivo: El vértigo posicional paroxístico benigno (VPPB) parece deberse a la migración de otoconias dentro de los conductos semicirculares o su adherencia a la cúpula. Si bien el origen de estas otoconias es la mácula del utrículo, aprovechando que los potenciales evocados miogénicos vestibulares (VEMP) valoran la función del sáculo, nuestro objetivo es estudiar su función en pacientes con VPPB. Pacientes y método: En 19 pacientes con VPPB por afección del conducto semicircular posterior, se valoró el nivel de audición, la respuesta de las pruebas calórica, rotatoria y VEMP. Se determinó en los VEMP ipsolaterales y contralaterales los umbrales, las latencias de las ondas p13 y n23 a 100 dB, la amplitud entre máximos y la diferencia de la amplitud interaural. Resultados: Se halló ausencia de respuesta de los VEMP en el 52 % de los oídos con VPPB. Cuando se corrigió por la ausencia de respuesta bilateral, los VEMP estaban ausentes en el 20,3 % de los casos. Conclusiones: En algunos pacientes con VPPB hay cierto grado de disfunción sacular

Objective: Benign paroxysmal positional vertigo (BPPV) seems to occur because of otoconia migration into the semicircular canals or their adherence to the cupula. Although the origin of these otoconia lies in the macula of the utricle, vestibular evoked myogenic potentials (VEMPs) can be used assess saccular function. The aim of this study is to assess the saccular function in patients diagnosed with BPPV. Patients and method: Nineteen patients diagnosed with BPPV of the posterior semicircular canal were included in this study. Their auditory function and their caloric, rotatory chair, and VEMP responses were tested. Ipsilateral and contralateral VEMP thresholds, ipsilateral and contralateral p13 and n23 latencies at 100 dB, inter-peak amplitude and the interaural amplitude difference were determined. Results: We found a lack of VEMP response in 52 % of the ears with BPPV. When adjusted for bilateral absence, VEMP response was absent in 20.3 % of ears. Conclusions: Some patients with idiopathic BPPV show a degree of saccular dysfunction