Customized Approach of Intratympanic Gentamicin in Ménière Disease

Introduction: Vertigo control is the goal of treatment in patients with Meniere’s disease (MD) and gentamicin has been proposed as an effective option. However, there is no consensus regarding the best application protocol. The aim of this study is to evaluate the efficacy of on-demand and low-dose intratympanic gentamicin (customized approach) in patients with intractable Meniere’s disease.

Methods: A cohort study was performed from June 2013 to November 2022 at a secondary care center. Patients with intractable Meniere’s disease who underwent intratympanic gentamicin (ITG) injections on a customized dose (from 5 mg to 25 mg) with an on-demand protocol were included. Meniere’s Class, Meniere’s Disease Functional Level Scale (MDFLS) and Dizziness Handicap Inventory (DHI) were determined pre and post gentamicin administration. Student's t-test was used for continuous variables and chi-square for categorical variables; p ≤0.05 was considered statistically significant

Results: Fifty-four patients were included, 25 (46%) men and 29 (54%) women with a mean age of 53 years. The number of ITG injections ranged from 1 to 14 with a mean of 3 applications per patient. DHI score was 54 points versus 25 points posttreatment (p≤0.001). Average MDFLS was level 3 pretreatment versus 2 posttreatment (p≤0.001). Mean follow-up was 1089 days. At the end of the study 37 (69%) patients reached Meniere’s Class A and 15 (28%) Class B. Two of our patients had class C and D respectively.

Conclusions: A customized approach of intratympanic gentamicin is an effective treatment option for vertigo control in patients with intractable Meniere’s disease.