Intratympanic gentamicin titration therapy for intractable Meniere's disease

Objective: This study aimed to assess the efficacy and morbidity of intraty mpanic gentamicin titration therapy on patients with intractable unilateral Meniere's disease. Study Design: The study design was a retrospective chart review and patient interviews. Setting: The study was conducted at a tertiary referral ambulatory dizzines s clinic at the London Health Sciences Centre, University Campus, from July 1992 to June 1997. Intervention: Eighty-three patients received weekly intratympanic gentamici n injections in their diseased ear. Treatments were terminated after four i njections or sooner if patients met clinical or audiologic criteria. Sixty- eight patients were available for detailed follow-up. Main Outcome Measures: Vertigo frequency, hearing status, personal disabili ty ratings, tinnitus level, and caloric responses before and after gentamic in therapy were measured. Results: Eighty-four percent of patients showed complete, and an additional 6% showed substantial, vertigo control. At 24 months, 17% of patients demo nstrated a clinically significant (10-dB) reduction in hearing, but 26% sho wed a significant hearing improvement. Overall, the group showed no combine d statistically significant changes in any of the hearing parameters. No pa tients had an "extreme" drop in hearing (>30 dB). Conclusions: Intratympanic gentamicin titration therapy provides excellent vertigo control with a low incidence of hearing loss.