Intentional ablation of vestibular function using commercially available topical gentamicin-betamethasone eardrops in patients with Meniere's disease: further evidence for topical eardrop ototoxicity.
OBJECTIVE
To determine whether the controversial findings of suspected ototoxicity from commercially available gentamicin sulfate and betamethasone sodium phosphate eardrops can be used in a therapeutic fashion to ablate (or attenuate) vestibular function in patients with unilateral Meniere's disease.


METHODS
Prospective case review.


METHODS
At a tertiary care dizziness unit at the University Health Network, Toronto General Hospital, University of Toronto (Toronto, Ontario, Canada), adults with unilateral Meniere's disease undergoing intratympanic ablation therapy were studied. After insertion of a tympanostomy tube with the patient under local anesthesia, patients instilled gentamicin containing eardrops three times daily until they became vertiginous for longer than 24 hours and then for an additional 2 days longer or for 1 month, whichever came first. Electronystagmographic caloric test responses were measured before treatment using bithermal water caloric and after treatment using air caloric tests. Main outcome measures included clinical titration of drops to the onset of prolonged vertigo. As well, post-treatment findings on electronystagmography and audiometry were compared with pretreatment testing.


RESULTS
Twenty patients were available for review. Fifteen patients had a significant reduction in caloric test responses compared with pretreatment values; among them, 10 patients had absent air caloric test responses on the treated side. In 10 patients hearing worsened according to the 1995 American Academy of Otolaryngology-Head and Neck Surgery Committee on Hearing and Equilibrium Guidelines for reporting in Meniere's disease.


CONCLUSIONS
Topical gentamicin-betamethasone eardrops can pass through a tube into the middle ear, where they may prove primarily vestibulo-ototoxic patients with Meniere's disease. The study further confirms clinical observations that gentamicin-containing eardrops might prove ototoxic, especially in noninflamed ears with a tympanic membrane defect.
Kaplan
Daniel M
DM
Department of Otolaryngology, University Health Network, Toronto General Hospital, University of Toronto, Ontario, Canada.
Hehar
Sukhminderjit S
SS
Bance
Manohar L
ML
Rutka
John A
JA
D000287:Administration, Topical; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use / Q000633:toxicity; D001623:Betamethasone / Q000008:administration & dosage* / Q000031:analogs & derivatives / Q000627:therapeutic use / Q000633:toxicity; D005260:Female; D005839:Gentamicins / Q000008:administration & dosage* / Q000627:therapeutic use / Q000633:toxicity; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use / Q000633:toxicity; D006801:Humans; D008297:Male; D008575:Meniere Disease / Q000188:drug therapy*; D008875:Middle Aged; D008876:Middle Ear Ventilation; D011446:Prospective Studies; D014724:Vestibular Function Tests; D014722:Vestibule, Labyrinth / Q000187:drug effects*
D000900:Anti-Bacterial Agents; D005839:Gentamicins; D005938:Glucocorticoids; C028994:betamethasone sodium phosphate; D001623:Betamethasone