Intratympanic Gentamicin for Meniere's disease (ITG)

Timothy C. Hain, MD• Page last modified: January 12, 2016

See also: IT gentamicin page

We are often asked for examples of individuals who have had good or bad experiences with ITG

I usually answer that I haven't ever done a study of our results, but estimate that about 90% do very well. Here are a few examples.

Case 1: A 75 year old man had a classic history of Meniere's first diagnosed 10 years ago. His symptoms gradually increased, and in Cctober a year prior, he had a spell of dizziness, roughly every 2 weeks. These were treated with diazepam and sleep. His hearing initially dropped at low frequencies on the right, and continued to deteriorate. He has right sided humming noises but without much fullness. His hearing test (below) shows the classic "peaked" low-tone sensori-neural hearing loss seen in Meniere's. An ENG showed only a modest decline on the right side, and rotatory chair test was normal. One of his spells he was standing, "felt it coming", but when he turned to go inside to get his medication, he ran into the fridge. He was afraid of having a spell while driving, and he stopped driving.

His local ENT doctor treated him with dexamethasone injections on the right side on several occasions, but the spells kept coming back. He was tried on betahistine, and was following a low salt diet, to no avail. To summarize, he has well documented Meniere's, that failed medical management, and significantly impaired his activities of daily life (i.e. he stopped driving).

He had intratympanic gentamicin injections done twice at our clinic, roughly 3 months apart. Symptoms continued after the first injection, so a second was decided upon. After the second injection, he had a dizzy spell starting about 7 days post injection, lasting about 24 hours, and with unsteadiness for about 2 weeks. This suggests that

On his followup examination, 3 months later, he had weak left-beating nystagmus, that increased with head-shaking and vibration and supine. He was back to driving, and reported no significant dizzy spells. We put him on "stand-by" -- meaning only yearly visits for hearing rechecks, with the expectation that hearing will continue to decline.

Overall, he appears to have a moderately good response to IT gentamicin - -there was a clear change in his physical exam, and he had the typical response to gentamicin (2 weeks of unsteadiness), but he did not have a strong a nystagmus as most. He may need a "touch-up" injection in a year.


Patient contributed stories.

(This is from an email).

Just for your feedback I am a 43 year old who had year long menieres disease type vertigo attacks and the low dose genamicin treatment absolutely eliminated all my attacks. My quality of life before and after are polar opposites. It was an absolute miracle. Just had to tell someone who gives much advice. Reading PA