TITRATION STREPTOMYCIN THERAPY IN MENIERES-DISEASE - LONG-TERM RESULTS

As soon as the use of streptomycin was started for the treatment of tu berculosis, its ototoxic effect was discovered. initial reports demons trated that streptomycin was successful in reducing vestibular respons es while preserving cochlear activity. Streptomycin sulfate has been u sed for almost half a century for the treatment of vertigo in patients with Meniere's disease. At the Gruppo Otologico, Piacenza, Italy, bet ween 1987 and 1995 we treated 16 patients with either bilateral Menier e's disease or with Meniere's disease in their only hearing ear, adopt ing the titration streptomycin therapy protocol of Graham et al. Three patients with follow-up periods of less than 2 years were not include d in this study. The ages of the patients ranged from 36 to 64 years w ith a mean of 49.2 years, The patients were observed for 2 to 8.8 year s. The dose of administered streptomycin varied from 14 to 49 gm. Epis odic vertigo was totally relieved in all of the patients after initial treatment, whereas hearing remained the same or was improved when com pared with the pretreatment levels. Five of the patients experienced r ecurring vertigo during a period of 4 to 24 months after initial treat ment. Oscillopsia persisted in two patients and ataxia in darkness per sisted in another two patients. Hearing was unchanged in 14 ears, impr oved in 2 ears, and worsened in 4 ears at the last follow-up evaluatio n, The overall outcome indicated that intramuscular titration streptom ycin therapy seems to be one of the most important therapeutic options in the treatment of disabling vertigo in patients with either bilater al Meniere's disease or Meniere's disease in an only hearing ear.