Intratympanic gentamycin therapy for Ménière's disease placed by tubal catheter with systemic isosorbide

Summary

In 1974, six patients with incapacitating unilateral Ménière's disease were given an empiric treatment with intratympanic gentamycin sulfate via the eustachian tube using a tubal catheter with a small side-branch. These patients then showed excellent results with relief from vertigo over a 13-year period. Since 1980, we have treated patients suffering from Ménière's disease with isosorbide. When patients could not be controlled with this therapy, isosorbide was given in addition to intratympanic gentamycin therapy using a tubal catheter. Of 75 patients with Ménière's disease who received gentamycin and isosorbide therapy, 41 patients could be evaluated by the classification for Ménière's disease proposed by the American Academy of Opthalmology and Otolaryngology (AAOO). Subsequent results showed that vertigo improved in 73% of the patients. According to the AAOO classification, 11 patients (27%) were group A, 16 patients (39%) were group B, and 4 patients (10%) were group C. Eleven patients were group D (27%) and experienced persistent vertigo despite treatment. Our experiences show that patients with severe Ménière's disease can be readily treated with intratympanic gentamycin therapy using a tubal catheter, even on an outpatient basis. This treatment is also a most effective treatment, as it allows the effects of isosorbide to be obtained with smaller doses of gentamycin sulfate.