Ménière's disease is characterised by three major symptoms: rotational dizziness (vertigo), hearing loss and ringing in the ears (tinnitus), sometimes accompanied by aural fullness. Intratympanic gentamicin is a relatively new therapy with promising results. Gentamicin is an antibiotic which damages the inner ear and the balance organ when it is applied behind the ear drum. This treatment may decrease the spells of vertigo in Ménière's disease. In this review we assess the effectiveness of this kind of treatment for Ménière's disease. Two randomised controlled trials, including a total of 50 patients, were identified which fulfilled the review inclusion criteria. Both of these found a beneficial effect of intratympanic gentamicin therapy for Ménière's disease, although the size of the effect differed between the two trials. Based on these findings, we conclude that intratympanic gentamicin may be an effective treatment for vertigo complaints in Ménière's disease, but it carries a risk of increasing hearing loss. Further research is needed to clarify the effect of intratympanic gentamicin on vertigo in Ménière's disease and the risk of inducing or increasing hearing loss.
Based on the results of the two included studies, intratympanic gentamicin seems to be an effective treatment for vertigo complaints in Ménière's disease, but carries a risk of hearing loss.
Ménière's disease is characterised by three major symptoms: vertigo, deafness and tinnitus, which may be accompanied by aural fullness, all of which are discontinuous and variable in intensity. While discontinuous, these symptoms are synchronous. Intratympanic application of gentamicin, an ototoxic aminoglycoside, is a relatively new ablative treatment for vertigo in Ménière's disease with promising results.
To assess the effectiveness of intratympanic gentamicin in the treatment of vertigo in Ménière's disease.
We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ISRCTN and additional sources for published and unpublished trials. The date of the most recent search was 30 June 2010.
All randomised or quasi-randomised controlled trials of intratympanic gentamicin versus placebo, or versus another treatment for Ménière's disease.
Two review authors independently assessed trial quality and extracted data. We contacted study authors for further information.
We identified two trials, involving 50 participants, which fulfilled the inclusion criteria. Both of these trials are prospective, double-blind, placebo-controlled randomised clinical trials on the effect of intratympanic gentamicin on vertigo complaints. After assessing the risk of bias of both studies, we concluded that one had a greater risk of bias and deemed the other to be of higher quality. Both of these trials found a significant reduction in vertigo complaints in the gentamicin group when compared to the placebo group. Due to clinical heterogeneity we could not perform a meta-analysis. One study described an increase in hearing loss in four patients (25%) treated with gentamicin while the other described no increase in hearing loss. No other adverse effects were noted by either study.