Streptomycin treatment for Meniere's disease.

This paper describes the author's 10-year experience using streptomycin sulfate in the treatment of Meniere's disease in the following: the classical Schuknecht ablation of the vestibular system in bilateral Meniere's disease (eight patients); the classical Schuknecht ablation of the vestibular system in unilateral Meniere's disease in the only hearing ear (five patients); the intratympanic treatment of unilateral Meniere's disease (four patients); and low dose intramuscular outpatient treatment in unilateral Meniere's disease (five patients). The results of bilateral vestibular ablation were similar to those obtained previously by Schuknecht and others: patients developed profound ataxia with a wide-based gait and oscillopsia, which improved rapidly over a period of months; approximately 30% of patients experienced significant improvement in hearing, which usually deteriorated again after several months; and all patients were relieved of vertigo. Patients with unilateral Meniere's disease in the only hearing ear responded similarly, and hearing was preserved in all cases. Intramuscular streptomycin ablation of the vestibular system is strongly recommended in place of surgery in the only hearing ear in Meniere's disease. Controlled intratympanic injection of streptomycin is not successful as yet because of difficulty in controlling the dose. Low dose subototoxic streptomycin treatment on an outpatient basis offers promise for relief of Meniere's attacks, and may improve hearing in some cases without producing the temporary disabling effects of ataxia and oscillopsia. Streptomycin and similar drugs which may reduce endolymph production may eventually be the treatment of choice for Meniere's disease.