[Ablation therapy with gentamycin in the treatment of Meniere's disease].

Historically the therapy for untreatable Ménière's disease (Md) has been surgery: conservative (cochleosacculotomy and decompression or sacco-endolymphatic shunt) or radical (labyrinthectomy and vestibular neurectomy). A valid alternative to surgery is the use of ototoxic drugs such as aminoglycoside antibiotics based on the assumption that some of the drugs exert greater ototoxicity vs. the posterior labyrinth. The purpose of the present study was to verify a severe protocol for the intratympanic administration of gentamicin sulfate in the treatment of Md unresponsive to medical treatment. A total of 29 patients were recruited for the study, all suffering from monolateral Md with reduced or normal (i.e. not absent) vestibular reflectivity on the side involved. The protocol called for audiovestibular testing prior to the treatment cycle and then 7 days after the administration of each individual dose. The same treatment scheme was used in all patients: a weekly intratympanic injection of gentamicin, 16 mg/per dose, for a maximum of 2 or 3 treatments. Of these cases, 20 have been followed up for 2 or more years and these are described in the present study. The follow-up called for suspending treatment and then repeating the audiovestibular tests every six months. Equilibrium was fully controlled in 70% of the patients while control was substantial in 30%. Audiometry showed that the auditory threshold remained unchanged in 60% of the cases while it worsened in 20% and, surprisingly, improved in the remaining 20%. In two cases deafness arose after the second treatment. The vestibular tests showed an uncompensated areflexia on the treated side after the therapeutic cycle although, in all cases, this had been compensated by the time of observation at 24 months. Symptoms of deafness remained unchanged. In conclusion, with respect to other more invasive treatments, chemical labyrinthectomy is simpler to perform and has fewer side effects while producing analogous clinical results.