IRRITATIVE SPONTANEOUS NYSTAGMUS FOLLOWING INTRATYMPANIC GENTAMICIN FOR MENIERES-DISEASE

Intratympanic aminoglycosides were first used to treat unilateral intr actable Meniere's disease over 30 years ago. Gentamicin, the current d rug of choice, provides excellent vertigo control with a low incidence of hearing loss. Its salutory effect results from direct damage to bo th the sensory neuroepithelium and the dark cells of the labyrinth. Th is latter effect may reverse the degree of endolymphatic hydrops. Twel ve patients with unilateral Meniere's disease were treated and prospec tively studied. Although further follow-up is necessary, 10 patients h ave complete vertigo control, while 2 remain significantly improved. T hree patients developed a spontaneous ''irritative'' nystagmus during the early post-treatment period. This new unique finding may represent a recovery phenomenon resulting from a temporary reversible ototoxic effect in the treatment ear. Despite our patients having a somewhat hi gher incidence of hearing loss compared to the reported rate, the resu lts of this treatment are encouraging.