Changes in the angular vestibulo-ocular reflex after a single dose of intratympanic gentamicin for Ménière's disease.

Abstract

Meniere’s disease is an inner ear disorder that causes episodic vertigo, hearing loss, tinnitus, and fullness in the ear. The clinical disorder has been associated with hydrops, a distension of the endolymphatic fluid compartment of the inner ear. The majority of patients can successfully control their attacks of vertigo with diuretics and restriction of sodium intake. However, about 30% of patients with Meniere’s disease have intractable vertigo that does not respond to these measures. The intratympanic (middle ear) injection of gentamicin is now an alternative to ablative surgery for these patients. Gentamicin is an aminoglycoside antibiotic that is toxic to the hair cells of the inner ear, with somewhat greater vestibular toxicity than cochlear toxicity. We have treated 102 patients with unilateral Meniere’s disease with intratympanic gentamicin. Attacks of vertigo have been completely controlled in 83%, and substantially controlled (>60% reduction in frequency) in 12%. Profound hearing loss occurred as a result of treatment in only 2%, and the overall rate at which hearing declined after treatment (19%) did not differ from the expected decline in hearing with active Meniere’s disease. Recent evidence suggests that a single dose of intratympanic gentamicin can be effective in controlling vertigo in Meniere’s disease. 1 This study was undertaken to determine the effect of a single intratympanic injection of gentamicin on the function of the human angular vestibulo-ocular reflex (AVOR) in subjects with Meniere’s disease.