Perfusion of the inner ear with streptomycin.

Any medical or surgical treatment of Meniere's disease is always suspect because the natural history is so variable and the pathologic physiology is not well-known. Even the occurrence rate in one and both ears is not known. It is certainly true that endolymphatic hydrops, caused by the failure of absorption of endolymph in the endolymphatic sac, is the principal pathology in the classical, fully developed Meniere's disease. While the endolymphatic shunt operation is correct in theory, in most ears, it does not work because the surgeon does not always locate the lumen of the sac and when located, the shunt tube does not remain open. While vestibular neurectomy is more likely to give permanent relief of vertigo as compared to the endolymphatic sac operation, the operation is difficult and dangerous and does nothing for the hearing. The vestibulotoxic action of the aminoglycocide antibiotics, especially streptomycin, when introduced into the perilymph of the lateral semicircular canal will destroy the vestibular receptors without making the hearing worse, and by acting on the dark cells, reduce the production of endolymph. Perfusion of the perilymph with streptomycin through an opening in the bony lateral semicircular canal is the operation of choice for Meniere's disease, benign paroxysmal postural vertigo and other forms of vertigo. So far 66 such operations have been done during the last three years with very encouraging results.