Author's reply to the Letter to the Editor "Therapeutic strategies in the treatment of Menière's disease: the Italian experience".

There is still controversy on the role of hyperinsulinemia and endogenous antisecretory factor (EAF) in Meniere's disease. In the literature, there is no mention on glucose uptake or specially processed cereals (SPC). Nevertheless, the role of EAF and its inhibition by SPC should be taken into account in future research. In case of patients not responding to medical treatment and dietary changes, intratympanic (IT) treatment has been suggested. In Italy, generalists consider IT steroids as the first-line treatment, while neurotologists suggest IT gentamicin. We agree with the authors that low-dose IT gentamicin has a high chance to treat vertigo with minimal risks for hearing; however, a recent randomized, double-blind, comparative trial has not proven the superiority of gentamicin to IT steroids suggesting the choice "should be made based on clinical knowledge and patient circumstances". IT steroids have the advantage to preserve both cochlear and vestibular function, while IT gentamicin has an ablative effect especially on the vestibular function.