The Laryngoscope Lippincott Williams & Wilkins, Inc., Philadelphia © 2003 The American Laryngological, Rhinological and Otological Society, Inc. Intratympanic Gentamicin for Intractable Meniere’s Disease Nicolas Perez, MD; Eduardo Martı ´n, MD; Rafael Garcı ´a-Tapia, MD Objective: The study aimed to analyze the results of the intratympanic injection of gentamicin as a treatment option for patients with unilateral Me- niere’s disease who were refractory to medical treat- ment. Study Design: Prospective study in the setting of a tertiary care medical center. Methods: Seventy- one patients with unilateral Meniere’s disease accord- ing to 1995 American Academy of Otolaryngology— Head and Neck Surgery 1995 guidelines who had been unresponsive to medical therapy for at least 1 year were studied. Intratympanic injections of a prepared concentration of 27 mg/mL gentamicin were per- formed at weekly intervals until the development of symptoms and signs indicative of vestibular hypo- function in the treated ear. As the main outcome mea- sure, the 1995 American Academy of Otolaryngology— Head and Neck Surgery criteria for reporting treatment outcome in Meniere’s disease were used. The results of treatment were expressed in terms of control of vertigo, disability status (functional level and degree of overall impairment evaluated by the Dizziness Handicap Inventory and the University of California Los Angeles Dizziness Questionnaire), hearing level, and quantitative measurement of ves- tibular function. Results: Vertigo was controlled in 83.1% of the 71 patients. Recurrence of vertigo spells after initially complete control was noted in 17 patients. In 13 of these patients, this was cured by another course of intratympanic injections of gentamicin. Functional level and measures of self- reported handicap were significantly and promptly lowered after treatment in the patients who at- tained control of vertigo. Hearing level as pure-tone average was unchanged 2 years after treatment, but hearing loss as a result of gentamicin injections occurred in 23 patients at the end of treatment and in 9 and 11 patients at 3 months and 2 years after the treatment, respectively. Vestibular function was kept normal or reduced in 49.3% of the patients, whereas in the rest of the patients vestibular areflexia was observed. Control of vertigo did not depend on the amount of vestibular damage. Con- clusions: Ending weekly intratympanic injections when clinical signs of vestibular deafferentation appear can control vertigo in the majority of pa- tients, and it is a useful alternative, together with other surgical options, for the treatment of patients with Meniere’s disease who do not respond to medical treatment. Key Words: Gentamicin, Meniere’s disease, vertigo, head-shaking nystag- mus, head-thrust sign, caloric test, rotary chair test, dynamic posturography, quality of life. Laryngoscope, 113:456 – 464, 2003 INTRODUCTION Meniere’s disease (MD) is a disorder characterized by episodic vertigo, aural fullness, tinnitus, and fluctuating hearing loss. Medical management of MD is based on the symptomatic treatment of the dizzy spells and prophylac- tic treatment with a salt-restricted diet and diuretics. For medically intractable MD, ablative surgery such as laby- rinthectomy or vestibular nerve section has been recom- mended. Both techniques generate a complete vestibular function loss in the side treated surgically. However, stan- dard labyrinthectomy techniques are always associated with deafness in the treated ear, and vestibular neurec- tomy requires a craniotomy, with the life-threatening complications that this entails. In an attempt to control vertigo while minimizing the morbidity associated with other procedures, many inves- tigators have developed the ototoxicity of aminoglycoside antibiotics in a procedure known as “chemical vestibular ablation.” 1 Over the last 15 years, a large number of authors have revisited this procedure using intratympanic gentamicin. 2 Fowler 3 was the first to prescribe systemic strepto- mycin to treat patients with bilateral MD, and Schuknecht 4 was the first to describe intratympanic injec- tions of aminoglycoside. Control of vertigo was excellent, but a profound hearing loss was seen in the majority of their patients. Since then, a great number of different protocols of intratympanic gentamicin administration have been developed, mainly based on the policy of deter- mining the complete or incomplete ablation of vestibular function. Beck and Schmidt 5 concluded in their series that ablation of the vestibular function was not necessary to obtain a complete control of vertigo, and that this policy From the Department of Otolaryngology, University Hospital and Medical School, University of Navarra, Navarra, Spain. Editor’s Note: This Manuscript was accepted for publication October 23, 2002. Send Correspondence to Nicolas Perez, MD, Department of Otolar- yngology, University Hospital and Medical School, University of Navarra, Pio XII, 36, 31008 Pamplona, Navarra, Spain. E-mail: nperezfer@unav.es Laryngoscope 113: March 2003 Perez et al.: Gentamicin in Meniere’s Disease 456