Low Dose Intratympanic Gentamicin for Control of Intractable Vertigo

Abstract

Background and Objectives: Intratympanic gentamicin therapy is an effective modality for control of vertigo in Meniere's disease (MD) and when given in low concentration (<30 mg/mL), once weekly minimizes its side effects like chronic vestibular insufficiency or hearing loss. We studied the efficacy of low dose interval intratympanic gentamicin therapy in control of intractable vertigo in MD and the postprocedure hearing loss. As gentamicin is vestibular end-organ selective and not specific for treatment of MD alone we studied its efficacy in non-Meniere's peripheral vertigo (NMPV) in patients with nonserviceable hearing in affected ear. Subjects and Methods: Our study included 13 patients with “Definite” MD and seven patients with NMPV. In MD group, one treatment series consisted of a maximum of 3 weekly intratympanic gentamicin injections of 0.3 mL (12 mg) of gentamicin. In NMPV group, the schedule was similar but dosage per injection was 0.5 mL (20 mg). Another similar series of injections were repeated for recurrences. Results: Significant reduction was noted in number of vertigo spells in both groups after treatment (P < 0.001). All the patients experienced either complete or substantial control (Class A or B) of their vertigo. The functional level scale had significantly improved posttreatment in both groups (P < 0.01). No significant worsening in hearing was noted in any of the patients in MD group. Interpretation and Conclusion: Low dose interval intratympanic gentamicin is a simple cost-effective office procedure for managing vertigo in patients with MD and in patients with NMPV and nonserviceable hearing.