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Intratympanic Gentamicin for Small Vestibular Schwannomas With Intractable Vertigo

Yang, Jie*,†,‡; Jia, Huan*,†,‡; Li, Gen*,†,‡; Huang, Meiping*,†,‡; Zhu, Weidong*,†,‡; Wang, Zhaoyan*,†,‡; Li, Yun*,†,‡; Wu, Hao*,†,‡

doi: 10.1097/MAO.0000000000001899
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Objective: To evaluate the objective and subjective effects of intratympanic gentamicin treatment in patients with small vestibular schwannomas who exhibit intractable vertigo.

Patients: Individuals diagnosed with small vestibular schwannomas who exhibited intractable vertigo were retrospectively reviewed.

Interventions: Intratympanic gentamicin injection.

Main Outcome Measures: Vertigo control.

Results: Eight patients were included in the study. All patients achieved complete or substantial control of vertigo attacks while six patients reported residual imbalance. Three patients experienced significant hearing loss during therapy and follow-up. Only one patient showed a drop from Class B to Class C. Caloric tests and vestibular evoked myogenic potentials showed that all patients exhibited impaired peripheral vestibular function before treatment and that unilateral vestibular deafferentation was achieved during follow-up. Dizziness Handicap Inventory scores decreased over time, indicating an increase in the quality of life.

Conclusions: Intratympanic gentamicin could provide an efficient approach to control intractable vertigo caused by small vestibular schwannoma. Before treatment, a complete physical examination, hearing level evaluation, vestibular function evaluation, and appropriate patient expectations are indispensable.

*Department of Otolaryngology Head and Neck Surgery, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University

Ear Institute, Shanghai Jiaotong University School of Medicine

Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China

Address correspondence and reprint requests to Yun Li, M.D., Hao Wu, M.D., Ph.D, No. 639 Zhizaoju Road, Shanghai 200011, China; E-mail: liyun_tougao@163.com, wuhao622@sina.cn

J.Y., H.J., and G.L. contributed equally to this article.

This work was supported by the National Natural Science Foundation of China (Grant No. 81670919 to W.Z., Grant No. 81700900 to W.Z., and Grant No. 81570906 to H.W.), the National Key Technology Research and Development Program of the Ministry of Science and Technology of China (Grant No. 2014BAI04B01 to H.W.), and Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases (Project Number: 14DZ2260300 to H.W.).

The authors disclose no conflicts of interest.

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