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Due to the risk of significant hearing loss with intratympanic gentamicin, each patient needs to consider if they are willing to sacrifice hearing (which may or may not already be compromised) in exchange for relief of vertigo. If one is not willing to take that risk, they should consider other surgical options.

Outcomes for treatment with intratympanic gentamicin for Meniere's disease include:

• Control of vertigo - 75-100%
• Risk of (additional) hearing loss - 0-37%
• Profound hearing loss - 3%
• Recurrence of vertigo - up to 30%

A study published in Acta Otolaryngolica in June 2007 reported that 6 months after 57 patients received intratympanic gentamicin the following data was obtained:

• Complete or substantial vertigo control - 80% of patients
• Hearing worsened - 15% of patients
• Word recognition scores worsened - 31% of patients

For approximately 49% of the patients, one injection was sufficient for vertigo control. For those needing multiple injections, there was a time interval of a minimum of 27 days between injections.

For more information about this study, please click on the following link: http://www.ncbi.nlm.nih.gov/sites/entrez?Db=PubMed&Cmd=ShowDetailView&TermToSearch=17503229&ordinalpos=11&itool=EntrezSystem2.PEntrez.Pubmed.PubmedResultsPanel.PubmedRVDocSum

A long term follow-up study completed in 2003 at Johns Hopkins University showed that of 34 patients who received intratympanic gentamicin, 90% experienced complete control of vertigo. Hearing deteriorated in 17% of patients. Twenty-nine percent of the patients experienced recurrent vertigo at 4-15 months after complete control was obtained. Readministration of the injection was effective for these patients with no increase of hearing loss.

For more information about the long-term results of intratympanic gentamicin delivery, please click on the following link: http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=12792316&ordinalpos=3&itool=EntrezSystem2.PEntrez.Pubmed.PubmedResultsPanel.PubmedRVDocSum

Although it was always considered important for the patient undergoing intratympanic gentamicin to have unilateral Meniere's with a healthy vestibular system of the contralateral ear to aid in central compensation, there is limited evidence that patients with bilateral Meniere's may also benefit. A small study completed in 1994 examined bilateral intratympanic gentamicin treatment for 14 patients with bilateral Meniere's disease. Results indicated that vertigo was eliminated in 11 patients and controlled in the remaining 3 patients. No patients experienced a significant change in hearing.

Vestibular Neurectomy

Vestibular nerve section (VNS) is the most efficient way of controlling vertigo attacks in Meniere's disease that are unremitting despite medical therapy. It is the most invasive of the surgical procedures available for Meniere's disease. The objective of VNS is the elimination of vertigo by cutting the vestibular portion of the 8th cranial nerve (vestibulochoclear nerve) while preserving hearing by keeping the cochlear portion of the nerve intact.

This procedure takes approximately 3-4 hours. The surgeon performs a craniotomy (part of the skull is removed) in order to gain access to the vestibular nerve and severs the fibers that lead to the brain. This destroys the balance mechanism in that ear (since signals are cut off from reaching the brain) but usually preserves hearing. The brain no longer receives conflicting messages from the affected vestibular system thus eliminating vertigo.