Postural compensation after intratympanic gentamicin treatment of Menière's disease

We have treated 93 patients with severe Menière's disease with gentamicin (GM) applied with 1 to 4 or intratympanic injections in a prospective study. The patients were tested at frequent intervals and followed up for two years. Postural stability was evaluated on posturography. Unsteadiness and gait between attacks, working capacity and vertigo were scored. Before commencing the treatment 47 of the patients complained from moderate to severe postural instability. After treatment moderate to severe postural instability was met in 19 patients. Initially the sway velocity was 27 mm/s on average being significantly worse than in referents. Two weeks after treatment the sway velocity increased to 33 mm/s. Thereafter the sway velocity slowly started to decline to 31 mm/s after two years. Patients with severe attacks of rotatory vertigo had a good postural outcome with GM treatment. In logistic regression analysis the most significant risk factor for poor recovery after GM treatment was severely reduced gait before commencing the treatment with odds ratio of 2.0. Subjectively, after two years, the patients rated their postural stability significantly improved when compared to pretreatment values. The good subjective rating of postural stability is related to postural training program where in the absence of attacks, the patients have learned to cope with daily tasks.