When and How to Use Gentamicin in the Treatment of Meniere's Disease

Abstract

Ödkvist LM, Bergenius J, Möller C. When and how to use gentamicin in the treatment of Meniere's disease. Acta Otolaryngol (Stockh) 1997; Suppl 526: 54–57.

Gentamicin given as local therapy for severe Meniere's disease is of considerable value in the control of vertigo. The ototoxic antibiotic is instilled through the tympanic membrane causing a peripheral vestibular loss and possibly also diminished endolymph production. In order to achieve the best results with gentamicin treatment it is of utmost importance that the diagnosis is correct. Given to a patient with vertigo of other than peripheral origin, the outcome would be worsening of the existing symptoms and addition of new ones. The method should be used only by physicians who are very familiar with vertigo and otology, and only in patients with such a disturbing degree of vertigo that they are well motivated to receive treatment. Thorough information regarding the disease, the treatment procedure and the symptoms caused by a unilateral peripheral vestibular loss should be given to the patient. Vestibular rehabilitation, including movement therapy, should be given by the physician or, preferably, a well trained physiotherapist on an individual basis or in patient groups together with written practice programmes for use at home. Vertigo attacks are usually relieved in 95% of patients. Twenty percent of patients experience an added hearing loss in the treated ear, although this number is reduced if the treatment is given as a single installment on consecutive days with extra installments given one month later if the vertigo remains.

Key Words:

• gentamicin
• Meniere's disease
• ototoxicity
• streptomycin
• vestibular compensation
• betahistine