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MicroWick-delivered transtympanic gentamicin: Hearing effects
Otolaryngology– Head and Neck Surgery Volume 131 Number 2
R028 Co-Morbidity of Migraine and Me ´ nie ` re’s Disease: Is Allergy the Link? Purushothaman Sen, FRCS (presenter); Christos Georgalas, MD; Michael Papesch, FRACS Woodford Green United Kingdom; London United Kingdom; London United Kingdom
Problem: The prevalence of migraine in Me´ nie`re’s disease (MD) has been reported. However, the factor(s) that link the two is yet to be established. The aim of this study was to assess the association between allergy and migraine in patients with MD. We tested the hypothesis that if migraine and Me´ nie`re’s disease are linked by allergy, allergy should be more prevalent in patients with MD and migraine than in the MD-without-migraine group. Methods: A Web-based questionnaire was used to recruit patients with MD (n ⫽ 108). The questionnaire was posted at many Me´ nie`re’s support Web sites. The control group consisted of patients who attended the ENT clinic for non-MD problems (n ⫽ 100). Age was matched in blocks of 5. Analysis included chi-square or Fisher t test for comparison of proportions and 2 ¨ C tailed t test as appropriate for continuous normally distributed variables. The criterion for statistical significance was taken as P ⬍ 0.005, two-tailed. Results: Of the 108 respondents with MD, 39% (42/108) reported a history of migraine. This prevalence was significantly higher than that found in the age and sex-matched control group, of which 18% reported to suffer from migraine (18/100, P ⫽ 0.001). Fifty-six of 108 (52%) patients with MD reported allergy. This was significantly higher than allergy in the control group (23/100, P ⬍ 0.001). Allergy was almost ubiquitous in Me´ nie`re’s patients who suffered from migraine (prevalence 71%, compared to 39% in nonmigraine sufferers, P ⫽ 0.0002). However, there was no link with any specific allergy types. Conclusion: History of allergy was more significant in patients who suffered from both migraine and MD than MD patients with no migraine. However, there was no susceptibility for a specific type of allergy. Significance: This study suggests the presence of an underlying immunological determinant that links migraine and Me´ nie`re’s disease. Support: None.
R029 How Much Does Dizziness Interfere in Me ´ nie ` re’s Disease Patients’ Quality of Life? Fernando F Gananca, MD (presenter); Fabiana Cunha; Flavio Parente Settani, MD; Anne Marbella; Katherine B. Myers; Peter Layde, MD MSc Sao Paulo Brazil; Sao Paulo Brazil; Sao Paulo Brazil; Milwaukee WI; Milwaukee WI; Milwaukee WI
Problem: To evaluate the impact of dizziness on the quality of life (QOL) in Me´ nie`re’s disease (MD) patients in and out of crisis and to verify a possible relationship between the QOL impairment and the clinical data. Methods: Fifty patients with diagnosis of definite MD were included in the study. The impact of dizziness on the QOL was assessed by the Dizziness Handicap Inventory (DHI), administered to the patients in and out of crisis. The DHI scores were correlated to the clinical data. Tinnitus, aural fullness, imbalance, and functional disabilities were evaluated according to the Inner Ear Profile (IEP), in and out of crisis. Vertigo was assessed by Vertigogram. Hearing was assessed by CHE AAO-HNS staging. Vestibular function was evaluated by computerized vectonystagmography. All patients were also analyzed regarding disease duration and unilateral or bilateral labyrinth involvement. Statistical analysis was performed by using Anova and the test of equality of 2 proportions. Results: The sample consisted of 39 females and 11 males, with a mean age of 50.8 years. The DHI, during the crisis period, showed physical, functional, and emotional aspects scores statistically higher (P ⬍ 0.001) when compared to the out-of-crisis period. The functional and physical aspects were the most impaired aspects in crisis and out of crisis, respectively. We found a statistically significant correlation among the physical, functional, and total scores and the bilateral labyrinth involvement out of crisis, when compared to in crisis. Conclusion: Definite MD patients present QOL impairment due to dizziness in and out of crisis. The impairment is worst in crisis when compared to the out-of-crisis period. The QOL impairment is greater in patients with bilateral labyrinth involvement out of crisis, than in patients with unilateral labyrinth involvement in the same period. Significance: Definite MD patients do have dizzinessrelated QOL impairment, independent of all clinical studied data. Support: None reported. R030 MicroWick-delivered Transtympanic Gentamicin: Hearing Effects Peter James Killian, MD; Michael E Hoffer, MD San Diego CA; San Diego CA
Problem: Transtympanic gentamicin administration has
POSTERS
dynamic remodeling of molecular chaperones by ATP treatment protect the cell from stress in Me´ nie`re’s disease. Significance: Our results indicate the importance of molecular chaperones and ATP treatment in Me´ nie`re’s disease. Support: None reported.
Research Posters P153
Research Posters
become a popular modality for the treatment of Me´ nie`re’s disease. This modality and other inner ear medical therapies are gaining increased clinical and scientific attention. We have previously described the kinetics and effects of gentamicin uptake into the inner ear after delivering the medicine into the middle ear using a variety of different techniques and sustained release modalities. In this study we focus on a newer sustained release device, the Silverstein MicroWick (Micromedical, Inc, Minneapolis, MN). Methods: We studied the effects of a single administration of gentamicin onto the microwick after implanting the wick into the round window membrane of Chinchilla laniger. One mg of gentamicin (10 mg/mL) was applied to a microwick after securing the wick in the round window niche of Chinchilla laniger. Hearing was measured before placing the wick and at the preset time points after. Results: All of the animals had normal preoperative hearing and there was no hearing loss demonstrated in the 4-hour time group. However, 40% of the animals in the 8-, 24-, and 48-hour time points exhibited a hearing loss. Conclusion: Despite the very low dose of gentamicin, we demonstrated more hearing loss at earlier time points than in previous experiments. The fact that 40% of animals demonstrated hearing loss at each time point suggests to us that the damage from gentamicin, delivered in this manner (a single low dose on a microwick), occurs early and those animals remain impaired for at least 48 hours. Meanwhile, animals whose hearing is intact for the first 8 hours likely do not suffer damage after that point. Significance: The information gained from this study and the follow-on studies will increase our scientific understanding about the effects of gentamicin on the inner ear and allow clinicians to more effectively treat patients with inner ear disorders. Support: None reported.
R031 The Prevalence of Me ´ nie ` re’s Disease in Finland Mari Havia (presenter); Erna Kentala, MD Helsinki Finland; Helsinki Finland
Problem: To study the prevalence of Me´ nie`re’s disease (MD) in the normal population in Southern Finland. The prospective 2-phase study included a random sample of subjects extracted from a population register. Methods: A detailed questionnaire was sent to 5,000 randomly selected people aged 12 years or more living in the Helsinki University Hospital area. The questionnaire asked whether the recipient had experienced vertigo associated with a moving sensation as well as possible hearing loss or tinnitus. For exclusion purposes we asked about the general illnesses, ear infections, former head and ear traumas, noise exposure, medication, and use of tobacco and alcohol. To
assess the validity of population-based study we randomly selected a 100-people cohort among those patients reporting vertigo. These people were clinically examined in our vestibular unit. The clinical examination was supplemented by audiologic and otoneurologic tests. Results: The response rate was 63% (n ⫽ 3138). The final study group consisted of 3116 persons. Two hundred and sixteen people reported the triad of vertigo, hearing loss, and tinnitus. By using the 1995 criteria of the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology⫺Head and Neck Surgery (AAO⫺HNS) we were able to identify 16 definitive MD patients from the total number of 3,116 giving the prevalence of 513/100,000 people. Among the 16 MD patients there were 10 patients who already had the MD diagnosed before and 1 patient was diagnosed during the clinical examination of the study cohort. Fifteen patients had documented hearing loss in audiometry. We were able to retrieve the medical records from our hospital archives. Conclusion: The prevalence of MD in the normal population is higher than earlier reported estimates of prevalence, which were based on hospital and/or primary care records. Significance: The study provides a population-based estimate of MD’s prevalence. Support: None reported. R032 The Protective Effect of Isoflurane and Halothane on Noise-Induced Hearing Loss in Mice Jong W Chung, MD (presenter); Joung Uk Kim, MD; Hun Hee Kang; Hyun Jung Lee; Jeong-Su Woo, MD Seoul South Korea; Seoul South Korea; Seoul South Korea; Seoul South Korea; Seoul South Korea
Problem: Production of oxygen-free radicals and apoptosis are the mechanism of inner ear damage in noise-induced hearing loss. General anesthetics can inhibit the tissue metabolic activity, production of oxygen-free radicals, and apoptosis. We conducted this study to evaluate the protective effect of general anesthetics on hearing loss in noise-exposed mice. Methods: We used BALB/c mice with normal Preyer’s reflex. Mice were anesthetized with 1 - 1.5 MAC of isoflurane and halothane using end-tidal agent monitoring system with supplement of oxygen (4 L/min). Broad band white noise (120 dB SPL, 0.2 - 7 kHz) was used for induction of noiseinduced hearing loss. Mice were stimulated by noise for 3 hours daily for 3 consecutive days with or without anesthetics (control). Hearing level was evaluated by measuring auditory brainstem response before and after noise exposure. Results: The hearing level before noise exposure was 26 ⫾ 2 dB in the control group (n ⫽ 5). The level changed to 79 ⫾ 1 dB after 3-day noise exposure and to 82 ⫾ 1.5 dB 1 week after noise exposure. When we anesthetized the mice
POSTERS
P154
Otolaryngology– Head and Neck Surgery August 2004
R028 Co-Morbidity of Migraine and Me ´ nie ` re’s Disease: Is Allergy the Link? Purushothaman Sen, FRCS (presenter); Christos Georgalas, MD; Michael Papesch, FRACS Woodford Green United Kingdom; London United Kingdom; London United Kingdom
Problem: The prevalence of migraine in Me´ nie`re’s disease (MD) has been reported. However, the factor(s) that link the two is yet to be established. The aim of this study was to assess the association between allergy and migraine in patients with MD. We tested the hypothesis that if migraine and Me´ nie`re’s disease are linked by allergy, allergy should be more prevalent in patients with MD and migraine than in the MD-without-migraine group. Methods: A Web-based questionnaire was used to recruit patients with MD (n ⫽ 108). The questionnaire was posted at many Me´ nie`re’s support Web sites. The control group consisted of patients who attended the ENT clinic for non-MD problems (n ⫽ 100). Age was matched in blocks of 5. Analysis included chi-square or Fisher t test for comparison of proportions and 2 ¨ C tailed t test as appropriate for continuous normally distributed variables. The criterion for statistical significance was taken as P ⬍ 0.005, two-tailed. Results: Of the 108 respondents with MD, 39% (42/108) reported a history of migraine. This prevalence was significantly higher than that found in the age and sex-matched control group, of which 18% reported to suffer from migraine (18/100, P ⫽ 0.001). Fifty-six of 108 (52%) patients with MD reported allergy. This was significantly higher than allergy in the control group (23/100, P ⬍ 0.001). Allergy was almost ubiquitous in Me´ nie`re’s patients who suffered from migraine (prevalence 71%, compared to 39% in nonmigraine sufferers, P ⫽ 0.0002). However, there was no link with any specific allergy types. Conclusion: History of allergy was more significant in patients who suffered from both migraine and MD than MD patients with no migraine. However, there was no susceptibility for a specific type of allergy. Significance: This study suggests the presence of an underlying immunological determinant that links migraine and Me´ nie`re’s disease. Support: None.
R029 How Much Does Dizziness Interfere in Me ´ nie ` re’s Disease Patients’ Quality of Life? Fernando F Gananca, MD (presenter); Fabiana Cunha; Flavio Parente Settani, MD; Anne Marbella; Katherine B. Myers; Peter Layde, MD MSc Sao Paulo Brazil; Sao Paulo Brazil; Sao Paulo Brazil; Milwaukee WI; Milwaukee WI; Milwaukee WI
Problem: To evaluate the impact of dizziness on the quality of life (QOL) in Me´ nie`re’s disease (MD) patients in and out of crisis and to verify a possible relationship between the QOL impairment and the clinical data. Methods: Fifty patients with diagnosis of definite MD were included in the study. The impact of dizziness on the QOL was assessed by the Dizziness Handicap Inventory (DHI), administered to the patients in and out of crisis. The DHI scores were correlated to the clinical data. Tinnitus, aural fullness, imbalance, and functional disabilities were evaluated according to the Inner Ear Profile (IEP), in and out of crisis. Vertigo was assessed by Vertigogram. Hearing was assessed by CHE AAO-HNS staging. Vestibular function was evaluated by computerized vectonystagmography. All patients were also analyzed regarding disease duration and unilateral or bilateral labyrinth involvement. Statistical analysis was performed by using Anova and the test of equality of 2 proportions. Results: The sample consisted of 39 females and 11 males, with a mean age of 50.8 years. The DHI, during the crisis period, showed physical, functional, and emotional aspects scores statistically higher (P ⬍ 0.001) when compared to the out-of-crisis period. The functional and physical aspects were the most impaired aspects in crisis and out of crisis, respectively. We found a statistically significant correlation among the physical, functional, and total scores and the bilateral labyrinth involvement out of crisis, when compared to in crisis. Conclusion: Definite MD patients present QOL impairment due to dizziness in and out of crisis. The impairment is worst in crisis when compared to the out-of-crisis period. The QOL impairment is greater in patients with bilateral labyrinth involvement out of crisis, than in patients with unilateral labyrinth involvement in the same period. Significance: Definite MD patients do have dizzinessrelated QOL impairment, independent of all clinical studied data. Support: None reported. R030 MicroWick-delivered Transtympanic Gentamicin: Hearing Effects Peter James Killian, MD; Michael E Hoffer, MD San Diego CA; San Diego CA
Problem: Transtympanic gentamicin administration has
POSTERS
dynamic remodeling of molecular chaperones by ATP treatment protect the cell from stress in Me´ nie`re’s disease. Significance: Our results indicate the importance of molecular chaperones and ATP treatment in Me´ nie`re’s disease. Support: None reported.
Research Posters P153
Research Posters
become a popular modality for the treatment of Me´ nie`re’s disease. This modality and other inner ear medical therapies are gaining increased clinical and scientific attention. We have previously described the kinetics and effects of gentamicin uptake into the inner ear after delivering the medicine into the middle ear using a variety of different techniques and sustained release modalities. In this study we focus on a newer sustained release device, the Silverstein MicroWick (Micromedical, Inc, Minneapolis, MN). Methods: We studied the effects of a single administration of gentamicin onto the microwick after implanting the wick into the round window membrane of Chinchilla laniger. One mg of gentamicin (10 mg/mL) was applied to a microwick after securing the wick in the round window niche of Chinchilla laniger. Hearing was measured before placing the wick and at the preset time points after. Results: All of the animals had normal preoperative hearing and there was no hearing loss demonstrated in the 4-hour time group. However, 40% of the animals in the 8-, 24-, and 48-hour time points exhibited a hearing loss. Conclusion: Despite the very low dose of gentamicin, we demonstrated more hearing loss at earlier time points than in previous experiments. The fact that 40% of animals demonstrated hearing loss at each time point suggests to us that the damage from gentamicin, delivered in this manner (a single low dose on a microwick), occurs early and those animals remain impaired for at least 48 hours. Meanwhile, animals whose hearing is intact for the first 8 hours likely do not suffer damage after that point. Significance: The information gained from this study and the follow-on studies will increase our scientific understanding about the effects of gentamicin on the inner ear and allow clinicians to more effectively treat patients with inner ear disorders. Support: None reported.
R031 The Prevalence of Me ´ nie ` re’s Disease in Finland Mari Havia (presenter); Erna Kentala, MD Helsinki Finland; Helsinki Finland
Problem: To study the prevalence of Me´ nie`re’s disease (MD) in the normal population in Southern Finland. The prospective 2-phase study included a random sample of subjects extracted from a population register. Methods: A detailed questionnaire was sent to 5,000 randomly selected people aged 12 years or more living in the Helsinki University Hospital area. The questionnaire asked whether the recipient had experienced vertigo associated with a moving sensation as well as possible hearing loss or tinnitus. For exclusion purposes we asked about the general illnesses, ear infections, former head and ear traumas, noise exposure, medication, and use of tobacco and alcohol. To
assess the validity of population-based study we randomly selected a 100-people cohort among those patients reporting vertigo. These people were clinically examined in our vestibular unit. The clinical examination was supplemented by audiologic and otoneurologic tests. Results: The response rate was 63% (n ⫽ 3138). The final study group consisted of 3116 persons. Two hundred and sixteen people reported the triad of vertigo, hearing loss, and tinnitus. By using the 1995 criteria of the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology⫺Head and Neck Surgery (AAO⫺HNS) we were able to identify 16 definitive MD patients from the total number of 3,116 giving the prevalence of 513/100,000 people. Among the 16 MD patients there were 10 patients who already had the MD diagnosed before and 1 patient was diagnosed during the clinical examination of the study cohort. Fifteen patients had documented hearing loss in audiometry. We were able to retrieve the medical records from our hospital archives. Conclusion: The prevalence of MD in the normal population is higher than earlier reported estimates of prevalence, which were based on hospital and/or primary care records. Significance: The study provides a population-based estimate of MD’s prevalence. Support: None reported. R032 The Protective Effect of Isoflurane and Halothane on Noise-Induced Hearing Loss in Mice Jong W Chung, MD (presenter); Joung Uk Kim, MD; Hun Hee Kang; Hyun Jung Lee; Jeong-Su Woo, MD Seoul South Korea; Seoul South Korea; Seoul South Korea; Seoul South Korea; Seoul South Korea
Problem: Production of oxygen-free radicals and apoptosis are the mechanism of inner ear damage in noise-induced hearing loss. General anesthetics can inhibit the tissue metabolic activity, production of oxygen-free radicals, and apoptosis. We conducted this study to evaluate the protective effect of general anesthetics on hearing loss in noise-exposed mice. Methods: We used BALB/c mice with normal Preyer’s reflex. Mice were anesthetized with 1 - 1.5 MAC of isoflurane and halothane using end-tidal agent monitoring system with supplement of oxygen (4 L/min). Broad band white noise (120 dB SPL, 0.2 - 7 kHz) was used for induction of noiseinduced hearing loss. Mice were stimulated by noise for 3 hours daily for 3 consecutive days with or without anesthetics (control). Hearing level was evaluated by measuring auditory brainstem response before and after noise exposure. Results: The hearing level before noise exposure was 26 ⫾ 2 dB in the control group (n ⫽ 5). The level changed to 79 ⫾ 1 dB after 3-day noise exposure and to 82 ⫾ 1.5 dB 1 week after noise exposure. When we anesthetized the mice
POSTERS
P154
Otolaryngology– Head and Neck Surgery August 2004