Intratympanic Therapy - For Meniere's Disease

Gentamicin and steroids can be used intratympanically to treat Meniere’s disease. This means they are injected into the tympanum, or middle ear, through the ear drum. This is done with a minor surgical procedure performed in the office.

Gentamicin is used in patients to stop attacks of vertigo. It is a medication which is toxic to the inner ear, but is more toxic to the vestibular cells than the hearing cells of the inner ear. This can allow elimination of enough vestibular cells to stop vertigo attacks without a significant change in hearing.

Dr. Jennifer Maw considers using gentamicin in patients who are poor candidates for other surgeries, or who decline surgery. Complications can include lack of benefit, a hole of the eardrum, reduced hearing and imbalance. The risk of hearing reduction in the treated ear is approximately 20%.

Steroids are usually reserved for the treatment of Meniere’s patients who have had a sudden loss of hearing that is not responding to other treatment and a course of oral steroids. Researches are trying to determine if this is truly beneficial in Meniere’s disease, but the risk seems to be low. This treatment is occasionally considered for patients with vertigo attacks not controlled by other medications and therapies, but research is again not conclusive as to it’s efficacy in Meniere’s vertigo treatment.

The normal ear drum - Ear Associates, San Jose, Ca The ear numbed at a spot with Phenol, Ear Associates, San Jose, CA Intratympanic injection with a syringe, Ear Associates, CA
The normal ear drum The ear numbed at a spot with Phenol Intratympanic injection with a syringe

Procedure:

The injections are performed with the patient lying down and using the office microscope. The ear is first cleaned of wax. A small area of the eardrum is numbed with a drop of medication. A small needle and syringe are then used and the needle is passed through the eardrum at the site that is numbed so that the tip is in the ear, near the round window. This is a membrane where drugs are absorbed in to the cochlea. The fluid is injected in to the middle ear and the patient stays lying down for 20-30 minutes during which he does not swallow or sniff. The drug sits against the round window and is absorbed in to the inner ear. The patient then sits up slowly and leaves the office. Patients should not drive for a few hours after this procedure. Water is kept out of the ear until it is confirmed that the tiny hole has healed.

In some patients, a ventilation tube is placed in to the eardrum and the medication is injected through the tube. <link to VT insertion>. This can allow the patient to self treat with drops at home and is sometimes performed.

Complications

  • A hole in the eardrum - This is rare and occurs more with steroid use than gentamicin use. It is higher when a ventilation tube is placed and Intratympanic steroid therapy is performed. The holes are usually small and can usually be repaired in the office.
  • Dizziness - This is usually short lived. Worsened dizziness and imbalance have been reported in research studies
  • Loss of hearing - In up to 20% with gentamicin therapy, rare in steroid therapy
  • Infection -This is rare

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