Treatments for Meniere’s disease: Fact, Fiction, or Biological Plausibility, Part X

                           Gentamicin Risks

This is the final installment in this series, and I intentionally finish with Intra-Tympanic Gentamicin (ITG) because it appears to be the most effective technique in managing the frequency and severity of episodic vertigo caused by Meniere’s disease. More recently, some physicians are using very low doses of ITG, and report fewer side effects. In short, the benefits of ITG can be great, but the side effects can be devastating and permanent. Dr. Neil Bauman offers a simple and straightforward description of the risks associated with ITG:

“This treatment can work great and ‘kill’ the balance system in one ear, hopefully eliminating the severe vertigo. But what happens if later your Meniere’s switches to your other ear, as it does in approximately 20% to 25% of the people with Meniere’s?

“With your balance system dead in one ear, you don’t dare do the same procedure on your other ear, or you will be left without any inner ear balance function at all. Among other balance problems, this will almost certainly result in such conditions as oscillopsia (bouncing vision), ataxia (staggering gait like you were drunk), blurred vision and other problems with your eyes. If this happens to you, you will never be able to drive again. You will likely find movement such as riding in a car, or even just watching action movies on your TV can make you ‘sick’.

“Third, there are no guarantees that, even in low doses, the Gentamicin will not affect your hearing. Gentamicin typically damages the balance system (a good thing in this case) more than it damages the hearing system (a bad thing)—but this is not always the case. Are you prepared to lose some or all of your remaining hearing in that ear? It can and does happen.

“If you have severe vertigo with your Meniere’s, (and I can’t even imagine what that must be like) and nothing else works, you may want to try this treatment. Remember, this is a treatment of “last resort”—one not to be taken lightly.”

 

Bottom line, there is no quick fix for patients with suspected or early Meniere’s disease. You need to manage the variables that you can control, the first being sure of your diagnosis. As I mentioned earlier in the series, about half of the people who come to my office with a previous diagnosis of Meniere’s disease do not have the condition. They were misdiagnosed. So make sure you understand the condition and the methods available for correct diagnosis. Do your homework. Get a second opinion. Travel to a vestibular specialty lab if there is not one locally. Most of all, hang in there. The symptoms of Meniere’s disease are not permanent, and there is a high likelihood things will improve over time.

 

 

About Alan Desmond

Dr. Alan Desmond is the director of the Balance Disorders Program at Wake Forest Baptist Health Center, and holds an adjunct assistant professor faculty position at the Wake Forest School of Medicine. In 2015, he received the Presidents Award from the American Academy of Audiology.