Round window gentamicin mu-catheter--a new therapeutic tool in Ménière's disease.

The vestibulotoxic effect of gentamicin is well documented; however, there is no general agreement on the gentamicin dose needed to control vertigo attacks without affecting the hearing. In the current study, 14 patients with Ménière's disease refractory to medical treatment were treated by small doses of gentamicin delivered via a mu-catheter, placed into the round window niche. An electronic micropump delivered 10 microliters (100 micrograms)/h. The patients received a total dose of 4-14 mg. The effects on the vestibular symptoms were most encouraging, with cessation of vertigo in 13 of the 14 patients, control of Tumarkin attacks in 4 out of 6 cases and release of aural pressure and fullness in 2 out of 4 cases. According to the recommendations of the Committee on Hearing and Equilibrium, the patients in this material belonged to functional levels 5 and 6. At the last clinical follow-up, five patients were classified as level 1, eight patients as level 2 and one patient as level 3. A significant hearing loss was seen in one patient; however, this was most likely due to the natural development of the disease in this particular case. The results look promising, but must be investigated further in a placebo-controlled study.