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[Intravenous gentamicin therapy in bilateral Menière disease]
1Universitäts-Hals-Nasen-Ohrenklinik Essen.
Background:
The treatment of severe forms of bilateral Menière's disease remains an especially challenging task. Similar problems also occur in debilitating Menière's disease in the only hearing ear. The intramuscular titration therapy with streptomycin has been the means of choice since 1984 to minimize the risk of total hearing loss in cases of severe bilateral disease.
Method:
Since 1989 we have treated six out of 21 cases of bilateral Menière's disease by intravenous application of 2 x 120 mg gentamicin in Ringer's solution for several days. Additionally we reported on two cases in 1988. Only minor amounts of gentamicin were applied to sedate the function of both vestibular organs while avoiding damage to the cochlea.
Results:
In two cases hearing approved approximately about 10 dB, in two cases hearing remained stable, and in two cases hearing worsened about 10 dB. Five of six patients showed minor excitability in caloric tests on both sides, they did not complain of vertigo attacks one to five years after therapy.
Conclusion:
Given that only very small amounts of gentamicin are applied to sedate the function of the vestibular organ while causing almost no damage to the cochlea, this method seems to be an excellent means for treatment of bilateral Menière's disease. Patients do not experience severe problems with equilibrium afterwards, and the treatment can be repeated as often as necessary.
Insights
Intravenous gentamicin offers a promising treatment for severe bilateral Menière
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.