Chemical and physical labyrinthectomy for Meniere's disease.

The use of intratympanic gentamicin is currently a popular and easily performed office procedure for the conservative treatment of the Meniere's disease patient who has failed medical therapy or who is not a candidate for surgical therapy. The procedure provides excellent control for the symptom of vertigo. Despite this success, there remains a significant risk of hearing loss irrespective of administered dose. In the future, antioxidant [42,43] or salicylate therapy may prevent aminoglycoside toxicity [44]. These prophylaxis methods have shown promise in the laboratory. Current methods do not allow for accurate drug delivery to the inner ear. Middle ear mucosal status, round window thickness or adhesion, patency of eustachian tube, and the effect of endolymphatic hydrops on ototoxicity are factors simply out of the control of the operator's hands. Judging by the number of recent articles, intratympanic gentamicin instillation will continue to be an area of interest for the otologist. Users should be encouraged to be consistent and conservative in gentamicin dosing. It is clear that vestibular ablation is not necessary for adequate control of vestibular symptoms and that larger doses may increase the risk of hearing loss. American Academy of Otolaryngology-Head and Neck Surgery guidelines [45] should be used and adhered to for reporting on the treatment of Meniere's disease, so that the literature may be more comparable. In the same light, a prospective standardized trial would be helpful in determining ultimate efficacy and risk to the patient. Transmastoid labyrinthectomy remains the surgical standard for extirpating the offending labyrinth when hearing preservation is not an issue. In appropriate patients, the procedure is a safe and effective method for relieving patients of vertiginous attacks. Most patients tolerate the procedure very well and are able to compensate fairly well over the course of several weeks to months.