Intratympanic gentamicin therapy for vertigo in nonserviceable ears

Purpose: Intratympanic ototoxic agents have become a widely accepted means of managing vertigo in patients with Meniere's disease while preserving res idual hearing. We investigated expanding the indications for intratympanic gentamicin to include control of vertigo in patients without serviceable he aring in the involved ear caused by a variety of end-organ pathologies. Materials and Methods: We present a retrospective series of 6 patients suff ering from vertigo caused by end-organ disease, in an ear without serviceab le hearing. Two patients suffered from delayed endolymphatic hydrops, 3 fro m Meniere's disease, and 1 from poststapedectomy vertigo. These patients ch ose unilateral vestibular ablation with serial intratympanic gentamicin inj ection rather than labyrinthectomy for a variety of reasons. Conventional e lectronystagmography (ENG) testing and audiometry were completed on all pat ients. The ENG testing included bithermal calories and rotational testing. All patients had a magnetic resonance image with gadolinium to exclude retr ocochlear or central pathology. Rotational testing was repeated before each injection and at the conclusion of therapy to assess changes in the periph eral vestibular response. The patients' subjective response to therapy was followed. Results: Follow-up has been 10 to 69 months with successful control of vert igo in all patients. Conclusions: Intratympanic gentamicin therapy offers a minimally invasive, ambulatory, low morbidity, cost-effective means of managing vertigo in pati ents with nonserviceable hearing.