Streptomycin perfusion of the labyrinth

The combination of fluctuant hearing loss, fullness, tinnitus and dizzy spells we call Meniere's disease is thought to be caused by endolymphatic hydrops. Most patients with the clinical picture of Meniere's disease do have endolymphatic hydrops but some patients with endolymphatic hydrops do not have the clinical picture of Meniere's disease. It would appear there is an, as yet unknown, immune-mediated, cause for Meniere's disease, in addition to endolymphatic hydrops, and this immune-mediated cause may aggravate those ears with endolymphatic hydrops. While medical treatment with a low-salt diet, diuretics and steroids are of value in some patients when given early in controlling dizzy spells and improving the hearing, there is usually no real, long-term benefit. Since none of these "shunts" of the sac could remain open for more than a few hours, they could have no more direct benefit than a one-time drainage of endolymph, while doing harm to the fluid absorption, immune response and phagocytosis roles of the endolymphatic sac. The various vestibular neurectomy operations, while usually stopping the dizzy attacks, are both difficult and potentially dangerous, but more important, do nothing for the hearing loss. The one direct attack on the problem, both easy to perform and certain to relieve the dizzy attacks, is to destroy the vestibular receptors with streptomycin. This destructive action on the stereocilia and sensory cells, without damage to the rest of the vestibular system and the cochlea, has been verified by two cat experiments with streptomycin by Norris et al. and Norris & Shea and two guinea pig experiments with gentamicin by Kimura.(ABSTRACT TRUNCATED AT 250 WORDS)