Outcome of Intratympanic Gentamicin Injection for Ménière Disease

Abstract

Objective: Intratympanic genemicin (ITG) is an option for the treatment of intractable Ménière disease (MD). The aim of this study is to investigate the outcomes of ITG for MD using evidence-based methodology. Method: The MedLine database (1985~2010) was searched for original articles (level I or II in evidence strength) published in peer-reviewed journals concerning ITG for MD. Data extracted from these articles were reviewed and analyzed using meta-analysis technology. Results: A total of 15 articles were clitically appraised; 2 prospective, double-blinded randomized control trials (level I) and 13 prospective noncontrolled clinical trials (level II) were indentified. The pooled vertigo control rates (American Academy of Otolaryngology Head and Neck Surgery guidelines for Ménière disease) from 15 studies are: overall control rate 78% (class A, 95% CI 0.67-0.85), substantial control rate 56 % to 98% (class A and B, 95% CI 0.25-1.0) following ITG treatment ( P = .0001). Hearing is worse in 0% to 61% (95% CI 0.02-0.83) after gentamicin treatment, which was neither clinically nor statistically significant ( P = 1.000). Conclusion: The critical literature and meta-analyses show that ITG can control vertigo for MD patients with limited injury to hearing. Quality of research has improved remarkably over the years. However, a large scale, randomized controlled trial is warranted to confirm the predicting factors for the true effectiveness of ITG in treating MD.