前庭型メニエール病に対するプロスタグランディンI₂誘導体の治療効果

抄録

We treated 44 cases of vestibular Ménière's disease with prostaglandin I₂ (PGI₂), a vasodialator, at a dose of 120μg per day for more than two months (mean: 8.0 months). The long-term administration of constant daily amounts of PGI₂ attained good long-term results in vertigo according to the criteria of the Japan Society for Equilibrium Research. The results were as follows: the administration of PGI₂ completely controlled vertigo in 65.9% (29/44) and improved it in 29.5% (13/44); however, four cases suffered from the typical type of Meniere's disease thereafter (9.1%: 4/44). The objective findings of nystagmus were also reduced in 85.7% (24/28) after PGI2 treatments.
PGI₂ was significantly more effective in patients with a vertigo duration within 120 min and -SP/AP negative results on electro-cochleogram (ECoG) than the others. On the contrary, patients with a vertigo duration of more than 120 min and -SP/AP positive results on ECoG experienced cochlear symptoms together with vertiginous sensations later. These patients should be treated with an oral osmotic diuretic, isosorbide. These findings suggest that cases presently diagnosed as vestibular Ménière's disease could include at least two kinds of oto-pathologies; vascular disease and endolymphatic hydrops.