Gentamicin injections for Ménière disease: Comparison of subjective and objective end points

July 31, 2008     Ronald Leif Steenerson, MD, Robin B. Hardin, MA, and Gaye W. Cronin, OTD


This retrospective study reports the overall efficacy and comparative results of intratympanic gentamicin injections for disabling vertigo episodes. All patients received weekly injections for diagnosed Ménière disease. In Group 1 (81 patients), treatment end points were determined by subjective complaints of imbalance, with resolution of vertigo. In Group 2 (23 patients), treatment end points were determined when 2 or more values of nystagmus were demonstrated. (Group 2 patients were assessed before initiation of therapy for head-shaking, head-thrust, and spontaneous nystagmus using infrared video goggles.) After the final injection, all patients had audiograms and balance and oculomotor retraining. Gentamicin therapy was determined to be successful based on 3-month post-therapy findings of vertigo resolution, stable hearing, normalized nystagmus, and functional balance.

Can a disorder of the vestibular system underlie an etiology for migraine?

April 30, 2008     Kenneth H. Brookler, MD, FRCSC

Endaural labyrinthectomy

March 31, 2008     Michael M. Paparella, MD

Neuroendocrine carcinoma of the jugular foramen

February 1, 2008     John P. Leonetti, MD, Mobeen A. Shirazi, MD, Sam Marzo, MD, and Douglas Anderson, MD


We describe what might have been the first reported case of a neuroendocrine carcinoma of the jugular foramen. A 50-year-old woman presented with progressive left-sided sensorineural hearing loss, vertigo, pulsatile tinnitus, headaches, and ataxia. Magnetic resonance imaging revealed a 4-cm left-sided jugular foramen tumor. The patient underwent near-total resection of the tumor. Despite lower cranial nerve preservation, postoperative paralysis of cranial nerves IX and X occurred, and vocal fold medialization was performed 5 days later. The final pathologic diagnosis was neuroendocrine carcinoma. The patient was treated with concurrent chemotherapy and intensity-modulated radiation therapy. This article will discuss the pathologic features and the management of jugular foramen tumors, along with the differential diagnosis of these rare tumors.

Ramsay Hunt syndrome, type I

March 1, 2007     Jagan Gupta, MD; Troy Hutchins, MD; Enrique Palacios, MD

ENG, sinusoidal vertical-axis rotation testing, and MRI in a patient with disequilibrium and nausea

February 1, 2007     Kenneth H. Brookler, MD; Mohamed A. Hamid, MD, PhD

Endolymphatic sac tumor: A report of 3 cases and discussion of management

January 1, 2007     Joni K. Doherty, MD, PhD; Mona Yong, MD; Dennis Maceri, MD

Long-term follow-up after gentamicin application via the Silverstein MicroWick in the treatment of Ménière's disease

July 31, 2006     Samuel L. Hill III, MD; E. Nicholas B. Digges, MD; Herbert Silverstein, MD, FACS
We conducted a retrospective study to evaluate the long-term effectiveness of gentamicin applied directly to the round window membrane via the Silverstein MicroWick system in patients with definite or probable Ménière's disease. The study population was made up of 69 patients who had received 3 drops of gentamicin 10 mg/ml three times daily; the duration of treatment was guided by objective data obtained from weekly electronystagmography and audiometry. Relief of vertigo was assessed by chart review and telephone interviews. After a minimum follow-up of 24 months, we found that vertiginous symptoms remained controlled in 53 patients (76.8%) after one or more courses of drug therapy. A single course of treatment was successful in 41 patients (59.4%). We conclude that long-term control of vertigo can be achieved in patients with Ménière's disease by direct application of gentamicin to the round window membrane via the Silverstein MicroWick. This minimally invasive self-treatment technique was well tolerated and free of long-term complications.

Vertigo and motion sickness. Part II: Pharmacologic treatment

January 1, 2006     Timothy P. Zajonc, MD; Peter S. Roland, MD
Vertigo is a sensation of movement when no movement is actually occurring. It is often accompanied by visceral autonomic symptoms including pallor, diaphoresis, nausea, and vomiting. Vertigo is similar to motion sickness in that both may be caused by vestibular stimulation that does not match an internal model of expected environmental stimuli. Indeed, a functioning vestibular system is necessary for the perception of motion sickness. For this reason, many of the same drugs are used to treat both conditions. The investigation of drugs that treat motion sickness helps to discover medications that may treat vertigo caused by disease of the vestibular system. In this article, we discuss the pharmacologic agents that are now available for the treatment of vertigo and those agents that are still under study.
of 3Next