Ménière Disease: Intratympanic Gentamicin or Dexamethasone

Abstract

Objective: Determine the efficacy (control of acute vertigo attacks) and effects on hearing (evaluated by pure tone average, PTA, and speech discrimination score) of low dose intratympanic gentamicin (IG) compared with intratympanic dexamethasone (ID) in patients with unilateral intractable “definite” Ménière Disease (MD). Method: This was an open, prospective study. Sixty patients affected with unilateral MD were enrolled between January 1, 2007, and June 30, 2008. A total of 32 patients were treated with IG (maximum 2 injections); 28 patients were treated with ID (4 mg/ml, 3 injections at intervals of one every three days). Results: At 2-year follow-up, in the gentamicin group, complete control of vertigo (class A) was achieved in 26 patients (81%), and substantial control of vertigo (class B) was achieved in 4 (12.5%). In the ID group, complete control of vertigo was obtained in 12 patients (43%), and substantial control was achieved in 5 (18%). Nine patients (32%) reported limited control despite 1 to 2 series of retreatment with ID. In the gentamicin group, 4 patients showed a reduction of PTA of 10 or more decibels. In the ID group, PTA results improved in 10 patients, were unchanged in 7 (belonging to class A-B), and were worse in 11. Conclusion: The results of this study suggest that IG achieved better outcome than ID in the control of vertigo attacks, with a very low incidence of hearing deterioration. ID was associated with good hearing preservation (only in class A-B subjects), but the control of vertigo spells showed a high failure rate.