Experience in Intratympanic Gentamicin Injection in Meniere's Disease: Comparison of Single Injection Protocol with Multiple Injection Protocol

Chung, Won Ho; Kim, Tae Wook; Jung, Jae Yun; Hong, Sung Hwa; Cho, Yang Sun

Abstract

BACKGROUND AND OBJECTIVES
Intratympanic gentamicin (ITGM) injection is established as the one of the treatment modalities for intractable Meniere's disease. Vertigo control rates have been reported up to 100%. But, one of the drawbacks is sensorineural hearing loss, the incidence of which is reported up to 30%. We analyzed the clinical efficacy of ITGM in patients with unilateral Meniere's disease who were refractory to medical treatment. We also compared the low dose (12 mg), single injection protocol with multiple injection protocol.
SUBJECTS AND METHOD
A retrospective review was conducted on 19 subjects who were diagnosed as unilateral Meniere's disease and treated with ITGM from May 1997 through November 2002. Nineteen subjects were divided into 2 groups: multiple injection group (n=10) and single injection group (n=9). Frequency of vertigo, functional level scale, pure tone threshold and caloric response were reviewed and analyzed according to the guideline of the AAO-HNS revised in 1995.
RESULTS
Vertigo was completely controlled in 80% of multiple injection group and 89% of single injection group. Functional status was also markedly improved in both groups. A significant hearing loss occurred in 71% of the multiple injection group but not in the single injection group. The decrease of caloric response observed in the multiple and single injection group was 87%, 83%, respectively.
CONCLUSION
ITGM was effective in the vertigo control and it showed the improvement in the functional status. Single injection protocol in our study proved to be as effective in vertigo control as the multiple injections but showed low possibility of secondary sensorineural hearing loss. We propose this protocol as an easy, well-tolerated, ambulatory and cost effective technique.