Intratympanic gentamicin injection in Ménière’s disease: our experience and outcomes

Title: Intratympanic gentamicin injection in Meniere’s disease: our twelve years’ experience and outcomes. Objective: The aim of our study is to evaluate the effectiveness of intratympanic gentamicin injection(ITG) on vertigo control with reduced doses and its hearing effects. Study design: Retrospective study Materials and Method: The study was conducted at our Otolaryngology Department of AORN “S.G. Moscati” between January 2005 and January 2015 on 72 patients with disabling unilateral Meniere’s disease treated with ITG. We use 0.2-0.3 mL of gentamicin sulfate at a concentration of 40mg/ml, injected into the affected ear through the posterior-inferior quadrant of the tympanic membrane. The procedure was carried out for three following days. Main outcome measures: vertigo control and hearing threshold changes after ITG treatment. Results: In the 98.6% of the patients (n=71) the ITG produced the full remission of the vertiginous symptoms. In the 91.6% of cases(n=66) a single treatment (three consequent injections) was sufficient to control vertigo, in the 5.5% of cases (n=4) two treatments were necessary to control vertigo and in the 1.3% of patients(n=1) three treatments were necessary to control vertigo. In no case we have had hearing loss after ITG procedure. The pre-treatment pure tone average was 48 db. The post-treatment pure tone average was 49.2 db. This difference was no statistical difference. Conclusion: In this study we reported high vertigo control, long follow-up and no case of significant hearing worsening. We consider the three injections in the following three days with low doses of gentamicin a safe and valid treatment for Meniere’s disease. Keyword : Meniere’s disease, intratympanic gentamicin injection, vertigo control, hearing worsening, aminoglycoside ototoxicity.