Middle ear ototoxic treatment for inner ear disease

Area of Science:

• Otolaryngology
• Neuroscience
• Pharmacology

Background:

• Ménière's disease is a disabling inner ear disorder characterized by vertigo, tinnitus, and hearing loss.
• Intractable symptoms necessitate alternative treatment strategies beyond conventional medical management.
• Intratympanic therapies offer a localized approach to managing inner ear disorders.

Purpose of the Study:

• To evaluate the efficacy and safety of intratympanic Gentamicin for severe Ménière's disease.
• To assess the impact of Gentamicin on vertiginous attacks, tinnitus, and aural pressure.
• To compare the risk-benefit profile with surgical interventions.

Main Methods:

• Twenty-nine patients with disabling Ménière's disease received daily middle ear Gentamicin injections.
• Treatment continued until the onset of inner ear disturbance (nystagmus, unsteadiness).
• Audiometric and clinical assessments were performed to monitor outcomes.

Main Results:

• Twenty-eight of twenty-nine patients (96.5%) experienced relief from vertiginous attacks and resumed normal activities.
• Tinnitus and aural pressure were significantly reduced or resolved in most patients.
• Hearing outcomes varied: slight improvement in 5, worsening in 9, and deafness in 2 ears; cochlear risk increased after 6 days.

Conclusions:

• Intratympanic Gentamicin is a highly effective treatment for disabling Ménière's disease refractory to medical therapy.
• The treatment offers a favorable alternative to surgery by avoiding intracranial complications.
• Careful monitoring is advised due to potential cochlear toxicity, with treatment duration being a critical factor.