ゲンタマイシン鼓室内注入による内リンパ水腫の治療

Intratympanic Injection of Gentamicin to Treat Endolymphatic Hydrops

　はじめに

　メニエール病の治療としては，利尿剤や内耳・脳循環改善剤などの内服が一般的に行われている。しかし，これらの治療に反応せずめまい発作を繰り返す症例も少なくはない。

　これらの症例に対しては，内リンパ嚢減荷術や迷路破壊術，前庭神経切断術などの手術治療も行われている^1）。また耳毒性をもつアミノ配糖体系抗生剤の投与も行われてきた^2）。今回われわれは，Nedzelskiらの方法^3）およびMagnussonらの方法^4）を参考に，ゲンタマイシン鼓室内注入による片側性内リンパ水腫症例の治療を試み，比較検討したので報告する。

In some patients with Ménière's disease, verti-genous attacks can not be controlled by medicine, diuretics etc. For these patients aminoglycoside have been used therapeutically since 1940'. At first streptomycin was used to inhibit vestibular function. Recently, gentamicin has been used to control endolymph secretion. We administered intratympa-nic infusion of gentamicin in patients with endolym-phatic hydrops using two methods after Nedzelski and Magnusson, and the results of two methods were compared. Eight patients included seven with Ménière's disease and one with delayed endolym-phatic hydrops. Although vertigenous attacks disappeared in four cases with Nedzelski's method, hearing was improved in only one. In four cases with Magnusson's method, the attacks diminished and hearing was preserved. To decrease the possible risk of delayed ototoxicity and preserve hearing function, we recommend reduction of the dosage of gentamicin.