The use of intratympanic gentamicin in patients with vestibular schwannoma and disabling vertigo.

OBJECTIVE

To document the effect of intratympanic gentamicin as treatment of disabling vertigo secondary to a vestibular schwannoma in elderly patients.

PATIENTS: Four elderly patients with a vestibular schwannoma, with an extrameatal diameter of less than 1 cm, experiencing disabling vertigo and followed a wait-and-scan policy.

INTERVENTION: Intratympanic injection of gentamicin.

MAIN OUTCOME MEASURES: Subjective improvement of quality of life and audiologic and vestibular assessment.

RESULTS

We obtained a subjective improvement in the quality of life for all the 4 patients. In fact, disabling vertigo disappeared in all cases; 3 patients recovered their posttreatment unsteadiness after a period of vestibular rehabilitation, whereas one of them complained of persistent unsteadiness. The hearing remained unchanged in 3 patients, whereas in one, the pretreatment severe sensorineural hearing loss progressed to anacusis.

CONCLUSION

This treatment represents an additional option in patients with small not-growing tumor affected by vestibular symptoms to be combined with a wait-and-scan policy.