It also is important to rule out any other causes of dizziness and nerve-related or inner ear hearing loss before jumping to more aggressive therapy with IT medications, Dr. Gurgel said. “We do that by obtaining a baseline MRI to make sure the patient doesn’t have a tumor or other structural anomaly that could be the cause of their balance problems,” he said.
Explore This IssueJanuary 2013
Once drug therapy is considered, Dr. Gurgel noted, the frequency of symptoms is an important factor. “If someone is having very active symptoms, IT steroids can help calm down a flare-up,” he said. “But for long-term control, studies have shown that gentamicin is more effective.” In one recent trial of long-term IT gentamicin treatments, the overall rate of successful vertigo control was 92.9 percent at two years of follow-up and 85.7 percent at an average follow-up of 10 years (Acta Otolaryngol. 2009;129:1420-1424).
As with sudden hearing loss, however, the dosage regimens used to treat Ménière’s disease vary considerably both in practice and in the literature, “so there’s not too much guidance there,” Dr. Gurgel said. “We tend to use 40 mg/mL in a single injection, to start.” The difficult question, he pointed out, is when to stop therapy if there is no appreciable response. “There can be diminished effectiveness after two or three injections, although for some patients, more may be warranted.” If there’s no improvement after diet and lifestyle changes, medical therapy and intratympanic injections, he added, “then surgical interventions may be considered.”