Chemical labyrinthectomy: local application of gentamicin for the treatment of unilateral Menière's disease.

The use of aminoglycosides for selective vestibular function ablation without hearing alteration is described in the literature. Parenteral administration of streptomycin for the alleviation of vertigo in cases of bilateral Meniere's disease is well accepted. The instillation of aminoglycosides into the middle ear to produce a similar result, has been successfully used in the treatment of unilateral Meniere's disease. However, the use of chemical vestibulectomy has not gained acceptance as a practical means of treatment when compared to vestibular neurectomy. The reason for this is not clear, but may stem from the lack of definitive protocol for the application and lack of treatment results that have been assessed according to an acknowledged standard (i.e., the American Academy of Otolaryngology Criteria). A prospective study was undertaken to examine the efficacy of chemical vestibulectomy as the treatment for vertigo in unilateral, incapacitating Meniere's disease. A standardized drug administration protocol was utilized, and academy criteria for the assessment of treatment were applied. This report details the first group of patients to complete 2 years of post-treatment follow-up. Based on our experience, we conclude that chemical vestibulectomy is an efficient alternative to surgery. A standardized regimen of drug administration that can be carried out on an outpatient basis is put forward.