Selective chemical vestibulectomy

In an attempt to destroy selectively the affected peripheral vestibular labyrinth in patients with intractable vertigo as a result of Meniere's disease, a known quantity of streptomycin was introduced within the bony labyrinth following fenestration of the horizontal semicircular canal. Initial laboratory results in animal models proved that near total ablation of the vestibular end-organs (including the hair cell population of the cristae ampularis, utricle, and to some extent the saccule) could be achieved chemically without involvement of the cochlear hair cell population. The exact dose required to accomplish this in the animal model was 250 micrograms of streptomycin. However, this dose proved excessive in initial human application possibly because the animals had excellent hearing in nondiseased ears while our patients uniformly had long standing inner ear disease with marked decrease in auditory thresholds. The current dose of streptomycin utilized is 125 micrograms, and patients treated thus far have maintained (or improved) their preoperative audiologic pure tone average. The aim of this preliminary report is to detail our developmental animal research and subsequent clinical application of selective chemical vestibulectomy (SCV) in 15 patients with intractable vertigo as a result of Meniere's disease, which have failed conventional medical management.