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Low Dose Intratympanic Gentamicin in Ménière's Disease
1Department of ENT, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeedham, Kochi, India.
Abstract:
Intratympanic gentamicin has become an accepted standard of care for Ménière's disease. But there still exists controversies regarding the dosing protocol as well as the drug concentration for optimum control of vertigo and hearing preservation. To determine if 20 mg of intratympanic gentamicin administered once a month for a maximum of 2 months can alleviate intractable vertigo caused by definite Ménière's disease with hearing preservation. Once diagnosed with definite Ménière's disease as per AAO-HNS criteria, the patient was given 0.5 ml of 40 mg/ml intratympanic gentamicin. Follow-up was done at 1-month and 6-month post-treatment. If at 1-month review patient continued to have vertigo one more dose of intratympanic gentamicin was administered. Thirty-two patients were included in the study. Seventeen patients (53.1%) received one dose and 15 patients (46.9%) received two doses of intratympanic injection. We achieved an effective vertigo control of 59.4% and complete vertigo control rate of 53.1%. Worsening of symptoms was noted in 1 patient. Hearing was preserved in all patients except for one. Among the patients who attained effective vertigo control, 72.2% had dead labyrinth at 6-month cold caloric status. A single injection of 20 mg intratympanic gentamicin can alleviate intractable vertigo caused by definite Ménière's disease with hearing preservation. Non-responders may be given a second dose after one month. Intratympanic gentamicin is a simple, cheap treatment that can be carried out in an out-patient setting.
Insights
A single 20mg intratympanic gentamicin injection effectively controlled vertigo in over 50% of Ménière
Area of Science:
- Otolaryngology
- Neurology
- Pharmacology
Background:
- Intratympanic gentamicin is a standard treatment for Ménière's disease.
- Controversies exist regarding optimal dosing and concentration for vertigo control and hearing preservation.
- This study investigates a specific dosing protocol for intractable vertigo.
Purpose of the Study:
- To evaluate the efficacy of a monthly 20mg intratympanic gentamicin dose for Ménière's disease vertigo.
- To assess hearing preservation with this treatment protocol.
- To determine if a second dose improves outcomes in non-responders.
Main Methods:
- Thirty-two patients with definite Ménière's disease received 0.5ml of 40mg/ml intratympanic gentamicin.
- Patients received one or two doses based on 1-month follow-up vertigo control.
- Follow-up assessments occurred at 1 and 6 months post-treatment.
Main Results:
- Effective vertigo control was achieved in 59.4% of patients; complete control in 53.1%.
- Hearing was preserved in all but one patient.
- 72.2% of those with effective vertigo control showed labyrinth 'death' on caloric testing at 6 months.
Conclusions:
- A single 20mg intratympanic gentamicin injection offers significant vertigo relief and hearing preservation in Ménière's disease.
- A second dose can be administered to non-responders after one month.
- Intratympanic gentamicin is a simple, cost-effective outpatient treatment.
