Irritative spontaneous nystagmus following intratympanic gentamicin for Menière's disease.

Intratympanic aminoglycosides were first used to treat unilateral intractable Meniere's disease over 30 years ago. Gentamicin, the current drug of choice, provides excellent vertigo control with a low incidence of hearing loss. Its salutory effect results from direct damage to both the sensory neuroepithelium and the dark cells of the labyrinth. This latter effect may reverse the degree of endolymphatic hydrops. Twelve patients with unilateral Meniere's disease were treated and prospectively studied. Although further follow-up is necessary, 10 patients have complete vertigo control, while 2 remain significantly improved. Three patients developed a spontaneous "irritative" nystagmus during the early post-treatment period. This new unique finding may represent a recovery phenomenon resulting from a temporary reversible ototoxic effect in the treatment ear. Despite our patients having a somewhat higher incidence of hearing loss compared to the reported rate, the results of this treatment are encouraging.