Intratympanic dexamethasone, intratympanic gentamicin, and endolymphatic sac surgery for intractable vertigo in Meniere's disease

OBJECTIVE: To compare the efficacy of intratympanic dexamethasone (ID), int ratympanic gentamicin (IG), and decompression of the endolymphatic sac (ESD ) for intractable vertigo in Meniere's disease. STUDY DESIGN AND SETTING: This prospective study was conducted at Hacettepe University Medical Faculty, a tertiary care center. Dexamethasone was appl ied through a ventilation tube in 24 patients, intratympanic gentamicin (al so through a ventilation tube) to 16 patients, and 25 patients underwent ES D. RESULTS: Satisfactory control of vertigo was 72%, 75%, and 52%, respectivel y for the ID, IG, and ESD. Two patients in the gentamicine group had total hearing loss. In the dexamethasone group, hearing level remained the some i n 46% of the patients with 16% increase and 38% decrease (30% 10dB and 8% 2 0 dB). CONCLUSION: If the vertiginous symptoms still persist after 6 months of med ical treatment, ID can be started. If there is no further improvement after 3 months with ID, patients with profound sensorineural hearing loss underg o treatment with IG, ESD is reserved for patients with good hearing. If ESD also fails, patients with good hearing may undergo vestibular nerve sectio n; patients with nonservicable hearing become candidates for labyrinthectom y.