Intratympanic dexamethasone, intratympanic gentamicin, and endolymphatic sac surgery for intractable vertigo in Meniere's disease.
OBJECTIVE
To compare the efficacy of intratympanic dexamethasone (ID), intratympanic gentamicin (IG), and decompression of the endolymphatic sac (ESD) for intractable vertigo in Meniere's disease.


METHODS
This prospective study was conducted at Hacettepe University Medical Faculty, a tertiary care center. Dexamethasone was applied through a ventilation tube in 24 patients, intratympanic gentamicin (also through a ventilation tube) to 16 patients, and 25 patients underwent ESD.


RESULTS
Satisfactory control of vertigo was 72%, 75%, and 52%, respectively for the ID, IG, and ESD. Two patients in the gentamicine group had total hearing loss. In the dexamethasone group, hearing level remained the same in 46% of the patients with 16% increase and 38% decrease (30% 10dB and 8% 20 dB).


CONCLUSIONS
If the vertiginous symptoms still persist after 6 months of medical treatment, ID can be started. If there is no further improvement after 3 months with ID, patients with profound sensorineural hearing loss undergo treatment with IG, ESD is reserved for patients with good hearing. If ESD also fails, patients with good hearing may undergo vestibular nerve section; patients with nonservicable hearing become candidates for labyrinthectomy.
Sennaroglu
L
L
Department of Otolaryngology-Head and Neck Surgery, Hacettepe University Medical Faculty, Ankara, Turkey. lsennar@tr-net.net.tr
Sennaroglu
G
G
Gursel
B
B
Dini
F M
FM
D000287:Administration, Topical; D019299:Decompression, Surgical; D003907:Dexamethasone / Q000008:administration & dosage*; D004712:Endolymphatic Sac / Q000601:surgery*; D005839:Gentamicins / Q000008:administration & dosage*; D006801:Humans; D008575:Meniere Disease / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D011446:Prospective Studies; D016896:Treatment Outcome
D005839:Gentamicins; D003907:Dexamethasone