%0 Journal Article
%T Dynamic Change of VOR and Otolith Function in Intratympanic Gentamicin Treatment for M¨¦ni¨¨re¡¯s Disease: Case Report and Review of the Literature
%A L. E. Walther
%A R. Huelse
%A K. Bl£¿ttner
%A M. B. Bloching
%A A. Bl£¿dow
%J Case Reports in Otolaryngology
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/168391
%X Intratympanic gentamicin treatment (IGT) is an evidence-based therapeutic option for recurrent vertigo attacks in M¨¦ni¨¨re¡¯s disease (MD). Today, in MD it is possible to monitor changes of vestibular receptor function, induced by IGT, with objective test methods such as the video head impulse test (vHIT) and cervical and ocular vestibular evoked myogenic potentials (cVEMP, oVEMP) in a dynamic, time-and frequency-dependent manner. We report on a 65-year-old female patient with recurrent vertigo attacks in a right-sided MD, where receptor function was followed up before and up to 4 weeks after IGT (time dynamic). Quantitative changes of vestibular function (frequency dynamic) were detected with bithermal calorics and vHIT, with air-conducted sound (ACS) cVEMP and bone-conducted vibration (BCV) oVEMP at 500£¿Hz. The horizontal vestibuloocular reflex (hVOR) gain in vHIT decreased successively until the 4th week with the appearance of catch-up covert and catch-up overt refixation saccades, and side asymmetry increased in caloric testing. Saccular function was extinguished within 4 weeks, whereas utricular function was diminished after 4 weeks. Monitoring vestibular receptor function with objective test methods provides a quantitative insight into the dynamic activity of vestibular function and is therefore applicable in order to adjust IGT regimen at different therapeutic stages. 1. Introduction Gentamicin plays an important role in otorhinolaryngology due to its ototoxic side effects. Intravenous administration may cause severe uni- or bilateral vestibular loss with imbalance and oscillopsia. If administered intratympanically, gentamicin vestibulotoxicity can be used to eliminate recurrent vertigo attacks in cases of intractable M¨¦ni¨¨re¡¯s disease (MD) [1¨C3]. For many patients, even at a higher age, intratympanic gentamicin treatment (IGT) is an evidence-based therapeutic option to restore quality of life [1, 2]. In IGT either a partial deficit or a complete loss of vestibular receptor function may occur. Today, canal and otolith functions are capable of being measured objectively and quantitatively by means of the video head impulse test (vHIT), cervical and ocular vestibular evoked myogenic potentials (oVEMP, cVEMP) [4¨C7]. These new tests provide the opportunity to monitor IGT-induced changes of vestibular function. Additional methods such as subjective visual vertical (SVV) and caloric irrigation may be helpful to confirm the functional status. When these tests are performed in a follow-up setting, a dynamic insight in receptor function with regard to time
%U http://www.hindawi.com/journals/criot/2013/168391/