Gentamicin and steroids can be used intratympanically to treat Meniere’s disease. This means they are injected into the tympanum, or middle ear, through the ear drum. The drug is then absorbed into the inner ear via a small opening called the round window. This is done as a minor surgical procedure performed in the office. It takes 30-60 seconds to perform, and the patient lies flat for 20-30 minutes before going home.
Gentamicin is used in patients to stop attacks of vertigo. It is a medication which is toxic to the inner ear, but is more toxic to the vestibular cells than the hearing cells of the inner ear. This can allow elimination of enough vestibular cells to stop vertigo attacks without a significant change in hearing. This is usually performed in patients with unrelenting vertigo despite medical therapy and who are poor candidates for other surgeries. Complications can include lack of benefit, a hole of the eardrum, reduced hearing and imbalance. The risk of hearing reduction in the treated ear is approximately 15%.
Intratympanic steroid therapy is frequently performed in patients with Meniere’s disease who have had a sudden loss of hearing or without oral steroids.
The injections are performed with the patient lying down and using the office microscope. The ear is first cleaned of wax. A small area of the eardrum is sometimes is numbed with a drop of medication. A small needle and syringe are then used and the needle is passed through the eardrum and the drug is then deposited in to the middle ear. The patient stays lying down for 20-30 minutes during which he does not swallow or sniff. The drug sits against the round window and is absorbed into the inner ear. The patient then sits up slowly and leaves the office. Patients should not drive for a few hours after this procedure. In some patients, a ventilation tube is placed in to the eardrum and the medication is injected through the tube. This can allow the patient to self-treat with drops at home and is sometimes performed.
