[Intravenous gentamicin therapy in bilateral Menière disease]

Area of Science:

• Otolaryngology
• Neurology
• Pharmacology

Context:

• Severe bilateral Menière's disease presents significant treatment challenges, particularly in patients with a single hearing ear.
• Intramuscular streptomycin titration was the established therapy since 1984 to mitigate hearing loss risk.
• Vestibular sedating therapies aim to manage debilitating symptoms while preserving cochlear function.

Purpose:

• To evaluate the efficacy and safety of intravenous gentamicin for treating severe bilateral Menière's disease.
• To assess the impact of low-dose gentamicin on vestibular function and cochlear integrity.
• To compare outcomes with existing treatment modalities for Menière's disease.

Summary:

• Six patients with bilateral Menière's disease received intravenous gentamicin (2 x 120 mg daily in Ringer's solution).
• Audiometric results showed hearing improvement in two, stability in two, and a 10 dB worsening in two cases.
• Five patients exhibited mild caloric excitability, with no vertigo attacks reported one to five years post-treatment.

Impact:

• Intravenous gentamicin provides effective vestibular sedation with minimal cochlear damage, making it a viable option for bilateral Menière's disease.
• This therapeutic approach avoids severe equilibrium disturbances and allows for repeated treatments if necessary.
• The findings suggest a favorable risk-benefit profile for intravenous gentamicin in managing refractory Menière's disease.