INTRATYMPANIC GENTAMICIN THERAPY FOR MENIERES-DISEASE

Objective: To evaluate the efficacy and toxicity of intratympanic gent amicin therapy for the treatment of Meniere's disease. Study Design: W e compared retrospective case series with historical controls. Setting : A tertiary referral center-the ambulatory clinic at The University o f Pittsburgh Medical Center. Patients: The study consisted of 28 patie nts with Meniere's disease who failed conventional medical therapy and were offered gentamicin treatment or surgical intervention. Patients had to be followed for at least 2 years to be eligible for review. Int ervention: Intratympanic gentamicin solution injections were given by serial titration to the involved ear on a weekly or biweekly schedule. Main Outcome Measures: Adhering to the American Academy of Otolaryngo logy-Head and Neck Surgery 1985 criteria for reporting treatment resul ts in Meniere's disease, the hearing status, control of vertigo, and d isability scores using intratympanic gentamicin therapy were reported and compared with historical controls. Results: Complete or substantia l control of vertigo was achieved in 91% of patients. Hearing loss occ urred in approximately one third of patients. Historically, similar he aring loss occurs in patients who were treated successfully, either me dically or surgically. Ototoxicity (high frequency hearing loss) was m ore likely to be seen in patients with pretreatment 8,000 Hz hearing t hresholds better than 65dB. Conclusions: Intratympanic gentamicin ther apy given by serial titration injections provides significant control of vertigo without the significant cost and potential morbidity of a m ore invasive surgical procedure.