The current role of local intratympanic gentamicin therapy in the management of unilateral Menière's disease.

Over the past 5 years 25 patients suffering from disabling unilateral Menière's disease have been treated in our unit with local intratympanic Gentamicin therapy with the specific intent of creating a medical labyrinthectomy, together with preservation of hearing on the treated side. Results from the 16 patients who have completed a 2-year follow-up show that substantial control of vertigo was obtained in all subjects, while 87% experienced complete control of vertigo following treatment. In 66% this was achieved in association with a complete medical labyrinthectomy (no caloric response to an iced water stimulus). In 94% of patients the hearing on the treated side has remained unaffected, but tinnitus was largely unchanged. The simple treatment protocol uses a customized self-retaining intratympanic catheter system (courtesy of Exmoor Plastics Ltd). The findings suggest that local Gentamicin therapy is an effective treatment in patients with incapacitating unilateral Menière's disease and is associated with low morbidity and good hearing preservation and thus provides a potentially superior alternative to the surgical treatment options currently available.