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To determine the effect of the Meniett® low-pressure generator on the subjective symptoms and audiovestibular disease markers of patients with unilateral Menière's disease unresponsive to betahistine treatment.
Randomised, placebo-controlled, double-blinded, clinical trial at a tertiary referral centre. After ventilation tube placement, patients were randomised to the active treatment or placebo group. Monitoring comprised audiometry and air caloric testing and a vertigo diary (enabling calculation of vertigo and activity scores, and the number of vertigo days, vertigo-free days and sick days).
Sixty-eight patients completed the study. For the active treatment versus placebo group, the following pre- and post-treatment values, and significances for treatment effect comparisons, were respectively seen: cumulative vertigo scores, 22.47 and 15.97 vs 20.42 and 19.23 (p = 0.048); vertigo days, 6.5 and 4.08 vs 5.94 and 5.52 (p = 0.102); sick days, 3.08 and 0.78 vs 2.87 and 3.45 (p = 0.041); vertigo-free days, 14.47 and 17.61 vs 15.48 and 17.58 (p = 0.362); activity score, 23.61 and 13.42 vs 24.68 and 20.23 (p = 0.078); low-tone hearing threshold, 49.15 and 53.18 dB nHL vs 41.66 and 46.10 dB nHL (p > 0.05); and slow phase velocity in response to caloric stimulation, 18.86 and 18.72 °/second vs 14.97 and 15.95 °/second, (p > 0.05).
Use of the Meniett® low-pressure generator improved patients' vertigo but not their hearing or vestibular function. This safe, minimally invasive treatment is recommended as second-line treatment for unilateral Menière's disease.
To assess the incidence of vestibular disturbance in patients after cochlear implantation, and to evaluate the quality of vertigo symptoms.
Prospective, observational study.
Cochlear implant centre at a tertiary referral university hospital, Munich, Germany.
Forty-seven adult patients undergoing unilateral cochlear implantation between 2003 and 2007.
Patients were interviewed post-operatively about vertigo symptoms, using a specifically designed questionnaire. Questionnaire data were used to define patient subgroups based on probable vertigo aetiology. Cochlear implantation was performed via a retroauricular, transmastoidal approach. Thirty-six implants were Cochlear Nucleus 24 devices and 11 were MedEl devices.
Twenty-one (45 per cent) patients reported vertigo symptoms following cochlear implantation. The time of onset was directly post-operatively in the majority of patients. In 90 per cent, the symptoms suggested an otogenic origin. The majority of patients reported paroxysmal vertigo with a duration of seconds to minutes. Typical concomitant symptoms were tinnitus, fluctuating hearing loss and vegetative reactions. Serious disablement by vertigo was rare.
Exposing patients to the risk of possible balance disorders associated with cochlear implantation is justified in view of the hearing rehabilitation achieved, even with today's broader indications for cochlear implantation. However, patients should in any case be informed about the possibility and quality of post-operative vertigo symptoms.
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