Intratympanic mixture gentamicin and dexamethasone versus dexamethasone for unilateral Meniere's disease

Abstract

Objective: This study aimed to determine the effectiveness of an intratympanic (IT) injection of a mixture of gentamicin and dexamethasone compared with intratympanic dexamethasone (ITD) for controlling vertigo and protecting the hearing level of Meniere's disease patients who have persistent vertigo attacks, despite medical treatment. Methods: Thirty eight patients with intractable Meniere's disease were included in this study. Twenty-one patients were treated with IT mixture gentamicin and dexamethasone injection; seventeen patients were treated with ITD. Pre- and post-treatment audiograms were compared with pure-tone averages. Control of vertigo was classified according to the American Academy of Otolaryngology Head and Neck Surgery (AAO-HNS) vertigo control index. Results: In the mixture group single IT injection was administered in 18 patients (85.7\%), 2 injections were administered in 2 patients (9.5\%) and 3 injections were administered in one patient (4.8\%). In the ITD group IT injection was performed 3 times (days 1,3,5) at intervals. The mean number of intervals per patient was 3,41 (range 1-6). Two years after IT treatment there was better control of vertigo in mixture group than in ITD group; 81\% of mixture group and 70,6\% of the ITD group achieved satisfactory control of vertigo (p = 0,0286). Audiology results of mixture group showed 20 patients (95,24\%) with unchanged hearing and 1 patient (4,76\%) with only 10-decibel deteriorated hearing. There was no worsening of hearing in the ITD group. Conclusion: The results of this study showed that an IT injection of a mixture of gentamicin and dexamethasone in intractable Meniere's disease cases is more effective than ITD for vertigo control.