Long-term results of low dose intramuscular streptomycin for Menière's disease.

The initial results of partial ablation of vestibular function are evident to control vertigo attacks and stabilize hearing as well as to reduce the severity of ataxia. The purpose of this study is to observe the long-term results of low dose intramuscular streptomycin in the treatment of bilateral Menière's disease. Eleven patients with disabling bilateral Menière's disease were treated with low doses of intramuscular streptomycin (20-40 g, mean = 25 g). Follow-up was 5-12 years (mean = 8 yr). All 11 patients achieved relief of their disabling vertigo. One patient had recurrent vertigo 1 year after treatment and streptomycin perfusion of the labyrinth was performed subsequently. Four patients reported feeling slightly off balance during follow-up. None experienced oscillopsia in this series. In the entire group of 11 patients (22 ears), hearing was unchanged in 17 ears, improved in two and worse in three. A hearing threshold of < 30 dB was found in two ears before and two after treatment; 30-60 dB was found in seven ears before and six after treatment; and > 60 dB was found in 13 ears before and 14 after treatment. The mean PTA of the 22 ears was 58 dB before and 65.5 dB after treatment. The mean speech discrimination scores were 61.4 percent before and 51.3 percent after treatment. The long-term results suggest that partial ablation of vestibular function by streptomycin has long-lasting effects of controlling vertigo attacks, stabilizing hearing, and reducing the severity of ataxia. Administration of low doses of intramuscular streptomycin is the treatment of choice for bilateral Menière's disease.