Treatment of intractable Menière's disease with intratympanic gentamicin: review of the University of Ottawa experience.
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OBJECTIVE: Intractable Meniere's disease has traditionally been treated surgically, with either labyrinthectomy, vestibular nerve section, or endolymphatic sac procedures. Another option is the use of intratympanic gentamicin to effect a 'gentamicin labyrinthectomy.' Nedzelski and coworkers have previously reported an 83% complete elimination and 17% substantial reduction in vertigo using this method. METHOD: We retrospectively reviewed 21 patients treated at our centre with intratympanic gentamicin between 1991 and 1995, all of whom fulfilled the criteria for reporting results in Meniere's therapy described in the American Association of Otolaryngology Committee on Hearing and Equilibrium 1995 guidelines. Our patients are presented using these guidelines, specifically examining four criteria: frequency of vertigo, word recognition, functional level, and hearing threshold. RESULTS: At 2-year follow-up, 17 of 21 patients (80.9%) had complete elimination of vertigo, with 3 of 21 (14.3%) reporting a 60 to 99% reduction in frequency. Nineteen of 21 patients (90.5%) described themselves as having no impairment secondary to dizziness. Average hearing thresholds and word-recognition scores appear to have both worsened after gentamicin therapy. CONCLUSION: Intratympanic gentamicin therapy for vertigo in Meniere's disease was shown to be an effective treatment choice, as shown by our results. However, with the reduction of average hearing thresholds and word-recognition scores, patients should be advised of these possible complications as part of informed consent.