Intratympanic gentamicin therapy for Menière's disease placed by a tubal catheter with systematic isosorbide.

In 1974 (6), 6 patients with incapacitating unilateral Meniere's disease were given an empiric treatment with intratympanic gentamicin sulfate via the eustachian tube using a catheter with a small side-branch. These patients showed excellent results, gaining relief from vertigo over a 13-year period. Since 1980 (7. 8), we have treated patients suffering from Menière's disease with isosorbide. When the patients could not be controlled by this therapy, isosorbide was given in addition to intratympanic gentamicin therapy using a tubal catheter. Of 75 patients with Menière's disease who received gentamicin and isosorbide therapy, 41 could be evaluated by the classification of the American Academy of Opthalmology and Otolaryngology (AAOO) in 1987 (9). Three of these patients suffered from repeated attacks of vertigo for 2 years. However, all of them could be easily controlled by additional intratympanic gentamicin or isosorbide therapy on an out-patient basis. Thereafter, of a further 40 patients with incapacitating Menière's disease who received gentamicin and isosorbide therapy, 15 could be evaluated by the AAOO classification. In summary, of the 115 patients with incapacitating Menière's disease treated with intratympanic gentamicin after isosorbide treatment, 56 could be evaluated by the AAOO criteria from 1987 to 1990. These patients ranged in age from 21 to 79 years. Vertigo improved in 80% of the patients: 19 patients (34%) were group A. 22 patients (39%) were group B, 4 patients 7%) were group C and 11 patients (20%) were group D, of whom 9 patients required subsequent endolymphatic-mastoid shunt operations. This treatment also effectively controlled patients with bilateral Menière's disease.