Middle ear ototoxic treatment for inner ear disease.

Twenty-nine patients seriously disabled by Ménière's disease due to frequent attacks were treated with Gentamicin administered in the middle ear once daily until first sign of an inner ear disturbance, usually a spontaneous nystagmus and a sensation of unsteadiness. All patients except one were relieved from their vertiginous attacks and returned to normal activities. Tinnitus was usually diminished or absent, as was the feeling of pressure in the ear. The hearing was slightly improved in 5 patients, worse in 9 patients and two treated ears became deaf. The indication for an intratympanal treatment with Gentamicin should be a disabling form of Ménière's disease not responding to medical treatment. The risk for the cochlea increases after 6 days of treatment. The advantage versus intracranial surgery is the absence of the surgical risks for complications. The mode of action exerted by the ototoxic drug is a destruction of the vestibular sensory epithelium and the endolymph producing cells.