Endolymph homeostasis and Meniere's disease. Fundamentals, pathological changes, aminoglycosides

Although low dose intratympanal gentamicin has empirically been very effective in treating Meniere's disease, the mechanisms of elimination or amelioration of vertigo are still insufficiently understood. Most animal studies investigating the effect of aminoglycosides used high doses that damage or kill hair cells and many other cell types of the inner ear. Additional studies are needed to investigate the effects of low dose gentamicin to elucidate the mechanisms affecting vertigo. In this article it will be explained how disturbances of endolymph homeostasis lead to endolymphatic hydrops and finally to leakage of K+ from the endolymph into the perilymphatic space. This can lead to a non-physiological activation of vestibular nerve fibres thus causing vertigo.