Refractory episodic vertigo: role of intratympanic gentamicin and vestibular evoked myogenic potentials

Publication date: Available online 28 March 2016
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Erika Celis Aguilar, Ramón Hinojosa González, Olivia Vales Hidalgo, Heloisa Coutinho Toledo
IntroductionEven today, the treatment of intractable vertigo remains a challenge. Vestibular ablation with intratympanic gentamicin stands as a good alternative in the management of refractory vertigo patients.ObjectiveTo control intractable vertigo through complete saccular and horizontal canal vestibular ablation with intratympanic gentamicin treatment.MethodsPatients with refractory episodic vertigo were included. The inclusion criteria were: unilateral ear disease, moderate to profound sensorineural hearing loss, and failure to other treatments. Included patients underwent 0.5–0.8mL of gentamicin intratympanic application at a 30mg/mL concentration. Vestibular ablation was confirmed by the absence of response on cervical vestibular evoked myogenic potentials and no response on caloric tests. Audiometry, electronystagmography with iced water, and vestibular evoked myogenic potentials were performed in all patients.ResultsTen patients were included; nine patients with Meniere's disease and one patient with (late onset) delayed hydrops. Nine patients showed an absent response on vestibular evoked myogenic potentials and no response on caloric tests. The only patient with low amplitude on cervical vestibular evoked myogenic potentials had vertigo recurrence. Vertigo control was achieved in 90% of the patients. One patient developed hearing loss >30dB.ConclusionsCervical vestibular evoked myogenic potentials confirmed vestibular ablation in patients treated with intratympanic gentamicin. High-grade vertigo control was due to complete saccular and horizontal canal ablation (no response to iced water in electronystagmography and no response on cervical vestibular evoked myogenic potentials).



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