On-Demand and Low Dose Intratympanic Gentamicin for Meniere's Disease: A Customized Approach

Objective:To evaluate the efficacy of on demand and low dose intratympanic gentamicin (ITG) in patients with intractable Meniere's disease (MD).Study Design:Clinical chart review.Setting:Secondary care center.Patients:Subjects with MD who failed conventional treatment and underwent on demand ITG infiltration from June 2013 to December 2018.Intervention:0.4 to 0.5ml of buffered gentamicin were administered through an intratympanic route. A total of 5mg in case of low dose and 20mg as a standard dose.Main Outcome Measures:Vertigo control, Meniere's Disease Functional Level Scale (MDFLS), Dizziness Handicap Inventory (DHI), and pure tone audiometry pre and posttreatment.Results:Thirty-one patients, 16 women and 15 men with a mean age of 52.81 (22-79) years were included. The number of ITG injections ranged from 1 to 7, with a mean of 2.52 applications per patient. Mean interval between doses was 212.15 (21-1442) days. Average follow-up was 24.03 months. An improvement on MDFLS was seen on 77.4% (n=24) patients. DHI score improved after gentamicin treatment (mean 55.23 versus 24.06, p <= 0.001). Thirty patients (96.8%) reached complete or substantial vertigo control. Only one patient did not achieve control. Hearing was preserved in 43.5% (n=10) of analyzed audiograms, whereas 17.4% (n=4) developed hearing loss greater than 20dB, which was not statistically significant (p=0.099).Conclusions:In our study, on demand and low dose ITG was effective for vertigo control in patients with intractable MD. Individualized therapy is recommended in all patients to minimize vestibular and cochlear toxicity.