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[27 years experiences with transtympanic aminoglycoside treatment of Menière's disease].

BACKGROUND
Severe unilateral Menière's disease is successfully treated intratympanically with ototoxic antibiotics. Gentamicin sulfate (Refobacin) gives the best results. The only disadvantage is that gentamicin may damage hearing in the treated side. Therapy is easier in patients with marked hearing loss prior to treatment.


PATIENTS AND METHOD
Since 1976 we treated 61 patients by injecting 8-12 mg Refobacin (0.2-0.3 ml) into the external auditory meatus between two and five times per day. By creating slight pressure (Politzer bag) the liquid is transported into the middle ear via a ventilating tube. From here it penetrates through the windows. The slightest indication of inner ear reaction was grounds for immediately terminating treatment.


RESULTS
In 54 of our 61 patients (follow-up 2-17 years) we were completely successful. Three further patients continued having very rare and weak spells, yet we regard them as being practically healed. We did not succeed in four of our cases. Twenty-nine patients suffered hearing loss. Hearing was mostly poor prior to therapy.


CONCLUSIONS
Transtympanic gentamicin therapy provides very good results in severe cases of unilateral Menière's disease. Spells of vertigo and vomiting are controlled. We propose individual dosage depending on hearing threshold and intensity of symptoms.