A Case of Tumarkin Otolithic Crisis; Failed to Treat with Intratympanic Gentamicin Injection

초록

Objectives: Tumarkin’s crisis is an unusual manifestation of Meniere’s disease that shows sudden falling without loss of consciousness. As a kind of otologic emergency due to high risk of injury, the surgical ablation therapy rather than the medical one is preferred. Recently, intratympanic injection of gentamicin (ITG) is being introduced as a treatment by chemical ablation of vestibular function. Although some doubts are emerging the effectiveness of ITG on Tumarkin’s crisis like less toxicity on macular hair cells, it is still widely recommended as a treatment. The authors report a case of Tumarkin’s crisis failed to treat with multiple application of ITG, and successfully eradicated the symptom with total labyrinthectomy after then. We report clinical characteristics also. Methods: A 76-year-old female visited clinic suffering from recurrent rotatory vertigo accompanied with fluctuating hearing loss and tinnitus on her left ear, and diagnosis of Meniere’s disease was made. Four months after medical treatment, the patient experienced sudden drop attack during walking on the street without prodromes, and her right wrist and skull base were fractured as a result. She denied to got surgery and ITG was applied. During 2 years after initial attack, she experienced 7 times of drop attack and 4 times of ITG, and finally she accepted to get surgery. The patient no longer suffered from drop attack after total labyrinthectomy until she died of colon cancer 2 years later. Results: During 2 years after initial attack, she experienced 7 times of drop attack and 4 times of ITG, and finally she accepted to get surgery. The patient no longer suffered from drop attack after total labyrinthectomy until she died of colon cancer 2 years later. Conclusions: Tumarkin’s crisis is an otologic emergency, may cause life-threatening falling. Our experience from this case is that vestibular ablation by surgical method is needed for safety and quality of life of the patient.