Disability in patients with Menière's disease following the use of two different treatment modalities: betahistine and intratympanic gentamicin

OBJECTIVE
The objective of this study was to assess the level of residual disability and handicap in patients with Menière's disease (MD) that were free of new vertigo spells 2 years after having been administered treatment with either oral medication or with intratympanic gentamcin.

SETTING
University hospital. Tertiary medical center.

MATERIAL AND METHOD
40 patients with MD were included in this study, of which 20 were treated with oral medication (betahistine) and 20 with intratympanic gentamicin; intratympanic gentamicin was for patients considered failures for the oral medication treatment. All of them are free of new vertigo in the 16-24 month period after beginning the treatment. They were matched by age and disease duration. Disability and handicap were assessed with conventional questionnaires at the time of inclusion and 2 years after beginning oral medication or ended the intratympanic gentamicin treatment. According to the treatment two groups were created: oral medication treatment and intratympanic gentamicin treatment.

RESULTS
The amount of disability before treatment was higher in patients treated with intratympanic gentamicin than in those under oral medication; However, after treatment when no more vertigo spells takes place, this disability is significantly reduced and becomes similar for both groups of patients. In patients treated with oral medication the items reflecting the intensity of vertigo spell, the impact of vertigo in daily activities, the perception of quality of life and level of somatization do not show a significant reduction.

CONCLUSION
The number or frequency of vertigo spells are very relevant for the process of disability and handicap of patients with MD when that is low or when oral medication is sufficient to eliminate vertigo spells. However when that number is high and the only possibility to arrest those vertigo spells is the use of intratympanic gentamicin, fear of vertigo must be considered as an associated problem for the patient.

CITA DEL ARTÍCULO Rev Laryngol Otol Rhinol (Bord). 2008;129(4-5):249-54