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Otology/Neurotology

(540) Vestibular Ablation Using Gentamicin Before Vestibular Schwannoma Surgery: Systematic Review

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time
Has Audio
Disclosure(s):
Tirth R. Patel, MD: No relevant relationships to disclose.
Samuel Meza, MD: No relevant relationships to disclose.


Introduction: Vestibular schwannoma surgery in patients who have intact ipsilateral vestibular function causes acute vestibular deafferentation. These patients must undergo considerable rehabilitation after surgery to achieve vestibular compensation. Potentially, achieving ipsilateral vestibular deafferentation prior to surgery may aid the process of compensation after surgery. Here, we perform a systematic review of studies examining the effects of pre-operative vestibular ablation using intratympanic gentamicin injections in patients undergoing vestibular schwannoma surgery.

Methods: A systematic review of three databases (MEDLINE, CINAHL, and Scopus) was performed according to PRISMA guidelines. Only English-language publications dating between January 1970 to December 2021 were included.

Results: A total 685 publications were identified for screening, of which eight publications were ultimately eligible for final analysis. Seven of these were cohort studies and one was a case series. Sample sizes ranged from eight to sixty total patients. Four studies excluded patients with pre-intervention abnormalities in ipsilateral vestibular function. Three studies excluded patients who were candidates for hearing-preservation. Gentamicin injection protocols varied slightly for all the studies. A variety of outcomes were measured. Two studies did not identify a difference in post-operative dizziness handicap index scores between patients who received pre-operative gentamicin injections and those who did not. Two other studies reported that patients receiving gentamicin had better postural control after surgery. One study illustrated that gentamicin patients had shorter duration of post-operative hospital stay while two other studies did not identify such a difference. One study reported a single patient who had worsening of pure tone audiometry thresholds after gentamicin injection.

Conclusions: There is no definitive consensus in the literature on the benefits of pre-operative intratympanic gentamicin injections for patients undergoing vestibular schwannoma surgery.