Long-term follow-up of transtympanic gentamicin for Meniere's syndrome

Objective: Recent studies have shown that transtympanic gentamicin for Meni ere's syndrome is effective. Current treatment protocols vary. One concept has been to perform a chemical ablation; the other has been to perform a ch emical alteration. Ablation requires multiple injections and is effective i n controlling the vertigo, but it is associated with a significant incidenc e of hearing loss. Chemical alteration uses a minimal dose to reduce vestib ular function without affecting cochlear function. Study Design: Prospective. Setting: Tertiary medical center. Patients: Patients had classic unilateral Meniere's syndrome that was unres ponsive to medical therapy. Intervention: A single injection of gentamicin is given, and the patient is seen 1 month after injection. If indicated, the patient receives another i njection and is reevaluated I month later. Main Outcome Measures: Control of vertigo and maintenance of hearing using the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HhTS) gui delines (1995). Results: Fifty-six patients have documented follow-up for 2 years or more, and 21 have 4 years or more of follow-up. This article presents the 4-year results as outlined by the AAO-HNS guidelines. Vertigo classes A and B were seen in 82% of patients. The patients followed 2 to 4 years had 86% vertig o class A and B results. Those followed 4 years or more show 76% with a ver tigo class A or B result. In this study there has been minimal cochlear los s. There was vestibular change clinically, which was documented by electron ystagmography. Conclusions: It appears that a single transtympanic gentamicin injection is effective in controlling the vertigo of Meniere's syndrome. Cochlear impac t has been minimal. It is most useful for those patients who have failed me dical management and are severely affected but not totally incapacitated by the disease.