Abstract

OBJECTIVE: Recent studies have shown that transtympanic gentamicin for M'eni`eretextquoterights syndrome is effective. Current treatment protocols vary. One concept has been to perform a chemical ablation; the other has been to perform a chemical alteration. Ablation requires multiple injections and is effective in controlling the vertigo, but it is associated with a significant incidence of hearing loss. Chemical alteration uses a minimal dose to reduce vestibular function without affecting cochlear function.

STUDY DESIGN: Prospective.

SETTING: Tertiary medical center.

PATIENTS: Patients had classic unilateral M'eni`eretextquoterights syndrome that was unresponsive to medical therapy.

INTERVENTION: A single injection of gentamicin is given, and the patient is seen 1 month after injection. If indicated, the patient receives another injection and is reevaluated 1 month later.

MAIN OUTCOME MEASURES: Control of vertigo and maintenance of hearing using the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) guidelines (1995).

RESULTS: Fifty-six patients have documented follow-up for 2 years or more, and 21 have 4 years or more of follow-up. This article presents the 4-year results as outlined by the AAO-HNS guidelines. Vertigo classes A and B were seen in 82% of patients. The patients followed 2 to 4 years had 86% vertigo class A and B results. Those followed 4 years or more show 76% with a vertigo class A or B result. In this study there has been minimal cochlear loss. There was vestibular change clinically, which was documented by electronystagmography.

CONCLUSIONS: It appears that a single transtympanic gentamicin injection is effective in controlling the vertigo of M'eni`eretextquoterights syndrome. Cochlear impact has been minimal. It is most useful for those patients who have failed medical management and are severely affected but not totally incapacitated by the disease.