Intratympanic gentamicin titration therapy for intractable Meniere's disease

Objective: This study aimed to assess the efficacy and morbidity of intratympanic gentamicin titration therapy on patients with intractable unilateral Meniere's disease. Study Design: The study design was a retrospective chart review and patient interviews. Setting: The study was conducted at a tertiary referral ambulatory dizziness clinic at the London Health Sciences Centre, University Campus, from July 1992 to June 1997. Intervention: Eighty-three patients received weekly intratympanic gentamicin injections in their diseased ear. Treatments were terminated after four injections or sooner if patients met clinical or audiologic criteria. Sixty-eight patients were available for detailed follow-up. Main Outcome Measures: Vertigo frequency, hearing status, personal disability ratings, tinnitus level, and caloric responses before and after gentamicin therapy were measured. Results: Eighty-four percent of patients showed complete, and an additional 6% showed substantial, vertigo control. At 24 months, 17% of patients demonstrated a clinically significant (10-dB) reduction in hearing, but 26% showed a significant hearing improvement. Overall, the group showed no combined statistically significant changes in any of the hearing parameters. No patients had an "extreme" drop in hearing (>30 dB). Conclusions: Intratympanic gentamicin titration therapy provides excellent vertigo control with a low incidence of hearing loss.