Hearing results and quality of life after streptomycin/dexamethasone perfusion for Meniere's disease

Abstract

Objectives/hypothesis: To evaluate the hearing changes and quality-of-life outcomes of 393 cases of streptomycin/dexamethasone inner ear perfusion performed by the primary author on 312 ears of 299 patients with Meniere's disease between July 2002 and May 2010.

Study design: Retrospective chart review.

Methods: Objective arm: A database was used to compile pretreatment and post-treatment audiograms as well as basic demographic information, dates of treatment, number of treatments, and which ear was treated. All patients met the 1995 American Academy of Otolaryngology-Head and Neck Surgery Committee on Hearing and Equilibrium Guidelines for the diagnosis and evaluation of therapy in Meniere's disease. All patients underwent one or more 3-day treatments consisting of daily intratympanic injections of a low-dose streptomycin/high-dose dexamethasone mixture plus intravenous dexamethasone. The end point for treatment was adequate control of vertigo. Subjective arm: The Meniere's Disease Outcomes Questionnaire survey was used to assess patients' quality of life after receiving streptomycin/dexamethasone inner ear perfusion. All procedures were performed by the primary author at the Shea Ear Clinic, a tertiary-referral otology clinic and outpatient surgery center.

Results: After a single 3-day treatment, the average change in pure tone average was 0.89 dB (±11). The average change in word recognition score was 0.49% (±17). The average number of days from treatment to follow-up audiogram was 94 with a range of 8 to 1,603. Clinically significant hearing loss occurred after 62 of 393 (15.7%) treatments. Severe hearing loss occurred after 20 of 393 treatments (5.0%). The percentage of ears with clinically significant hearing loss after all treatments was 56 of 312 (17.9%). A total of 215 surveys were returned from 383 patients (56.1%) to whom they were mailed. There were 90% of patients who indicated improvement in quality of life after treatment and 88% who indicated improvement in their "vertigo subscore," a domain within the survey that focuses on vertigo control.

Conclusions: Streptomycin/dexamethasone inner ear perfusion is as safe to the hearing of patients with Meniere's disease as other aminoglycoside regimens and provides a significant improvement in quality of life.