Intratympanic gentamicin injection for the treatment of Meniere's disease.
OBJECTIVE: This study aimed to examine the effectiveness of intratympanic injection of gentamicin as a nonsurgical treatment option in the treatment of patients with unilateral Meniere's disease who are refractory to medical treatment. STUDY DESIGN: The study design was a prospective case series. SETTING: The study was conducted at a physician's office setting in a tertiary care hospital. PATIENTS: The results of 37 patients who became eligible for reporting according to the American Academy of Otolaryngology Head and Neck Surgery (AAO-HNS) guidelines for reporting treatment results of Meniere's disease were reviewed. INTERVENTION: Intratympanic injections of a prepared gentamicin concentration of approximately 30 mg/ml were given weekly until the patient reported cessation of vertigo attacks. Patients reclined for 45 minutes after each injection. MAIN OUTCOME MEASURES: The 1995 AAO-HNS guidelines were used in this report, and measures included pure-tone hearing results, word recognition scores, vertigo control scores, and ice-water calories after a minimum of 24 months of follow-up. RESULTS: Vertigo control was achieved in 32 patients (87%). Fifteen patients (41%) had complete recovery from vertigo spells, 17 patients (46%) had substantial recovery, and 5 patients (14%) had treatment failure requiring additional surgery to control vertigo. Hearing results showed that 21 patients (72%) had unchanged or better hearing, 10 patients (28%) had an average threshold shift of 10-25 dB, 4 patients (11%) had a threshold shift between 16 and 25 dB, 1 patient (3%) had a threshold shift between 26 and 40 dB, and 1 patient (3%) had a threshold shift of > 40 dB. CONCLUSIONS: The authors found intratympanic gentamicin to be a useful alternative to surgery. The flexible treatment protocol allowed for better hearing monitoring compared to the more frequent injection schedules of other studies and yielded a lower rate of severe hearing loss. It had a higher failure rate for vertigo control and a greater amount of hearing loss than the author's experience with vestibular nerve section.