Menière's disease and gentamicin: preliminary results using the minimum effective dose and integrated therapy

Treatment of Menière's disease is aimed at restoring a normal quality of life and preserving residual hearing, in view of the increasing frequency with which the contralateral ear is affected. Conventional medical treatment (diuretics + vasoactive drugs) leads to cure in a large percentage of patients (75-95%). In intractable cases, transtympanic (intratympanic) aminoglycoside therapy, associated with various techniques, is becoming widespread as an alternative to surgery. Progressive reduction of the dose introduced into the middle ear did not prevent the onset of anacusis in several patients; the variable, unpredictable permeability of the round window membrane, the object of fundamental studies in the past, explains this complication. The Author has used gentamicin transtympanically in Menierians since 1978, and has treated a total of 105 patients. He first prescribed transtympanic gentamicin therapy that did not follow, but was integrated with conventional medical treatment in 22 intractable Menierians, by instilling the minimum effective dose, to reduce the risk of hearing impairment. Preliminary results, related to stage of disease, may be summarised as follows: improvement in the quality of life, as evaluated by the American Academy of Ophthalmology & Otolaryngology Committee on Hearing and Equilibrium questionnaire (14 patients--63.63%--at point 1 and 8-36.36%--at point 2); disappearance of vertigo in 15 patients (68.18%); a minor vertigo attack in 3 and two minor attacks in 3 others not affecting quality of life; persistence of occasional unsteadiness in one patient. Hearing remained unchanged in 15 patients, improved slightly in 3 cases and worsened slightly in 2; decreased sensitivity to high tones was observed in 2 patients at the first insertion of gentamicin. According to the Author, employing integrated therapy and using the minimum effective dose of gentamicin, the risk of damage to the cochlear structures may be reduced, although not excluded, while restoring a good quality of life, even when repeat instillation is necessary.