Round window gentamicin mu-catheter - a new therapeutic tool in Meniere's disease

The vestibulotoxic effect of gentamicin is well documented; however, there is no general agreement on the gentamicin dose needed to control vertigo at tacks without affecting the hearing. In the current study, 14 patients with Meniere's disease refractory to medical treatment were treated by small do ses of gentamicin delivered via a mu-catheter, placed into the round window niche. An electronic micropump delivered 10 mu l (100 mu g)/h. The patient s received a total dose of 4-14 mg. The effects on the vestibular symptoms were most encouraging, with cessation of vertigo in 13 of the 14 patients, control of Tumarkin attacks in 4 out of 6 cases and release of aural pressu re and fullness in 2 out of 4 cases. According to the recommendations of th e Committee on Hearing and Equilibrium, the patients in this material belon ged to functional levels 5 and 6. At the last clinical follow-up, five pati ents were classified as level 1, eight patients as level 2 and one patient as level 3. A significant hearing loss was seen in one patient; however, th is was most likely due to the natural development of the disease in this pa rticular case. The results look promising, but must be investigated further in a placebo-controlled study.