[Efficacy of intratympanic gentamicin and dexamethasone in the treatment of intractable Meniere's disease]

Objective:To investigate the efficacy and safety of low-dose intratympanic gentamicin (ITG) compared with intratympanic dexamethasone (ITD) in patients with intractable Meniere's disease (MD). Method:Seventy patients affected by definite unilateral MD were enrolled. 1 ml of gentamicin sulfate(40 g/L) was buffered with 0.5 ml of sodium bicarbonate to obtain a 6.4 pH solution with 26.7 g/L concentration. Thirty-five patients were treated with the buffered gentamicin solution on every week for 2 times. Thirty-five patients were treated with ITD (5 mg) in the first two days, and then every week for 4 weeks. At 2-year follow-up, mean outcome measurements consisted of control of vertigo attacks, pure tone average (PTA), dizziness handicap inventory and tinnitus handicap inventory.Result:Among 34 cases with complete follow-up data in the ITG group, complete control of vertigo (class A) was achieved in 27 patients and substantial control of vertigo (class B) in 5 patients. Among 32 cases with complete follow-up data in the ITD group, class A and B were achieved in 13 and 6 patients respectively (P< 0.05). There were no statistically significant variations between the two groups in PTA and THI (t= 1.737 and t=－0.197, P> 0.05).Conclusion:Low-dose ITG achieves better outcome than ITD in the control of vertigo attacks in patients suffering from unilateral intractable MD, with a very low incidence of hearing deterioration.

[Recent and long-term hearing outcomes in the cases after open tympanoplasty using titanium ossicular prosthesis]

Objective:To analyze recent and long-term hearing outcomes of the patients with chronic otitis media after open tympanoplasty using titanium ossicular prosthesis. Method:Retrospectively analyzed total 84 cases after open tympanoplaty with titanium ossicular prosthesis. The hearing outcomes before and after surgery(6 months and 24 months) were compared. Result:The hearing levels in the cases were improved to different degrees after surgery.Significant differences were showed compared the average pure tone threshold/air bone gap before surgery with the average recent/long-term outcomes after surgery(P<0.01),and no significant difference could be found compared the recent and long-term outcomes after surgery. Conclusion:Hearing level could be improved in the patients after open tympanoplasty using titianium ossicular prosthesis,and the long-term outcome could be steady.

[Clinical analysis of benign paroxysmal positional vertigowith multiple canal involvement]

Objective:To compare the clinical features and outcomes between patients with multi-canal benign paroxysmal positional vertigo(BPPV) and single-canal BPPV.Method:Five-hundred and seventy-eight patients with BPPV were retrospectively analyzed and divided into three groups: single-canal BPPV(526 cases),multi-canal BPPV in unilateral ear(11 cases) and multi-canal BPPV in both ears(41 cases).All patients were diagnosed by using the Dix-Hallpike test or roll test and treated with the canalith repositioning procedure.The following factors,including aetiology,age,sex,response to treatment and recurrence,were compared among the three groups.Results:①Greater percentage of idiopathic cases were identified in single-canal(66.2%:48.2%,P<0.01).Traumatic origin and prior history of BPPV were more common in bilateral multi-canal(41.6%:9.2%,P<0.05)and unilateral multi-canal (36.2%:0,P<0.01)respectively.②The recurrence rate was higher in multi-canal BPPV(40.4%:14.3%,P<0.01).Conclusion:Idiopathic BPPV is more common in single-canal BPPV.Potential causes may be identified in multi-canal BPPV.However,over 90% of the patients with single-canal and multi-canal BPPV are cured.

[Value of videonystagmography and electrocochleography in prognosis prediction of patients with acute low-tone sensorineural hearing loss]

Objective:To predict the prognosis of acute lowtone sensorineural hearing loss（ALHL）by using the videonystagmography(VNG) and electrocochleography(ECochG).Method:A retrospective study was done in 70 patients with ALHL after long-term follow-up. The recurrence rate and rate of progression to definite Meniere 's disease were determined according to the results of VNG and ECochG tests at the onset of the first episode of hearing loss.Result:Twentynine patients（41.4%）experienced recurrent hearing loss and 5 patients（7.1%）developed to Meniere's disease. In patients with an elevated SP/AP ratio and spontaneous nystagmus, the recurrence rate was 81.8%. However, in those with a normal SP/AP ratio and without spontaneous nystagmus, the recurrence rate was 23.3%.There was a statistically significant difference in the progression rate of Meniere's disease between the groups with(15.2%) and without spontaneous nystagmus.Conclusion:It has a certain reference value to predict prognosiswhen spontaneous nystagmus and an elevated SP/AP ratio are detected on initial examination in patients with ALHL.