Intratympanic gentamicin treatment of patients with Ménière's disease with normal hearing

OBJECTIVE: Understand the safety and outcomes of intratympanic gentamicin treatment in patients with Ménière's disease with normal hearing.

STUDY DESIGN: Case series with chart review.

SETTING: Tertiary referral center.

SUBJECTS AND METHODS: A total of 224 patients with disabling Ménière's disease treated between May 1996 and June 2007 were grouped according to the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) 1995 Committee on Hearing and Equilibrium staging guidelines: stage 1 (<25 dB pure-tone average [PTA]); stage 2 through 4 (>25 dB PTA). Patients underwent self-treatment with intratympanic gentamicin (10 mg/mL) three times daily for one to eight weeks. Outcome measures included pre- and post-treatment speech discrimination score (SDS), PTA, electronystagmography, vertigo relief, and statistical analysis utilizing the Pearson chi(2) test.

RESULTS: Twenty-two (88%) of 24 patients with stage 1 Ménière's disease showed unchanged or improved SDS. All 24 patients showed a mean PTA loss of 8 dB. Seventeen (71%) patients reported complete or improved vertigo control. One hundred sixteen (59%) of 200 patients with stage 2 through 4 Ménière's disease showed unchanged or improved SDS. All 200 patients showed a mean PTA loss of 11 dB. One hundred forty-eight (74%) patients reported complete or improved vertigo control.

CONCLUSIONS: Patients with stage 1 Ménière's disease appear to have similar vertigo control with better hearing preservation than patients with advanced disease when treated with low-dose intratympanic gentamicin (10 mg/mL).