• Home
  • Practice Focus
    • Facial Plastic/Reconstructive
    • Head and Neck
    • Laryngology
    • Otology/Neurotology
    • Pediatric
    • Rhinology
    • Sleep Medicine
    • How I Do It
    • TRIO Best Practices
  • Business of Medicine
    • Health Policy
    • Legal Matters
    • Practice Management
    • Tech Talk
    • AI
  • Literature Reviews
    • Facial Plastic/Reconstructive
    • Head and Neck
    • Laryngology
    • Otology/Neurotology
    • Pediatric
    • Rhinology
    • Sleep Medicine
  • Career
    • Medical Education
    • Professional Development
    • Resident Focus
  • ENT Perspectives
    • ENT Expressions
    • Everyday Ethics
    • From TRIO
    • The Great Debate
    • Letter From the Editor
    • Rx: Wellness
    • The Voice
    • Viewpoint
  • TRIO Resources
    • Triological Society
    • The Laryngoscope
    • Laryngoscope Investigative Otolaryngology
    • TRIO Combined Sections Meetings
    • COSM
    • Related Otolaryngology Events
  • Search

Meniere’s Disease: Experts Discuss Diagnosis and Treatment

by Thomas R. Collins • March 10, 2019

  • Tweet
  • Click to email a link to a friend (Opens in new window) Email
Print-Friendly Version

Intratympanic Gentamicin

For inner ear treatments, intratympanic gentamicin has been shown to be effective, but there is no strong agreement on appropriate dosing, timing, and delivery method, said Soha Ghossaini, MD, an otologist-neurotologist at Ear, Nose, and Throat Associates of New York. “We have to remember that intratympanic gentamicin can potentially cause hearing loss in a good percentage of the patients, depending on the dose,” she said.

You Might Also Like

  • Intratympanic Corticosteroid Treatment as Effective as Gentamicin for Ménière’s
  • AAO-HNS Updates Guidance on Ménière’s Disease Diagnosis, Treatment
  • Endolymphatic Shunt Surgery Comparable to Intratympanic Gentamicin in Controlling Vertigo in Ménière’s Disease
  • Are Diuretics Useful in the Treatment of Meniére’s Disease?
Explore This Issue
March 2019

A key question is when to use the drug in patients who have good hearing. “The consensus is to use them in patients with impaired hearing function and patients with good contralateral vestibular function,” she said.

Some researchers have advocated for a “titration” protocol and not systematic weekly or monthly injections, with end points of symptom resolutions and signs of hearing loss, realizing that these signs will be delayed by two or three days after treatment (Clin Otolaryngol. 2015;40:682-690). Tests such as ENG, VEMPs, and head-impulse test (HIT) were not found to establish end points for treatment with gentamicin, Dr. Ghossaini noted.

Intratympanic steroid therapy, particularly dexamethasone, is becoming more popular for vertigo control. Even though some studies have found that gentamicin controls vertigo better, steroids come with fewer risks, she said. She added that patients might need repeated treatments and that adding oral betahistine to steroid treatment has been shown in one study to produce better vertigo control. She added that no improvement in hearing has been found after long-term follow up.

Surgical Options

Surgical procedures for Ménière’s have been found to have a range in efficacy, Dr. Miller said.

Researchers have found that overpressure devices reduce vertigo frequency, but the results on hearing loss have been mixed (Clin Otolaryngol. 2015;40:682–690; Clin Otolaryngol. 2015;40:197–207; Cochrane Database Syst Rev. 2015;CD008419). The official American Academy of Otolaryngology-Head and Neck Surgery position is that there is “some medical evidence” to support their use as a second-level therapy after medical treatment has failed.

Endolymphatic sac surgery isn’t supported by histopathologic studies for shunt placement, but has been found to bring vertigo relief for some patients. “Although we don’t necessarily understand the basis behind it, it can be effective,” Dr. Miller said.

Vestibular nerve section has been found to lead to complete vertigo resolution in 85% of patients, based on two approaches that were studied, Dr. Miller said. The number isn’t 100%, she said, likely because the literature mostly reports on cases of transection of the nerve and not on cases that also involve destruction of Scarpa’s ganglion, which would bring about a more complete effect.

Cochleosacculotomy can be 60% to 80% effective in eliminating vertigo, she said.

Transcanal labyrinthectomy is a shorter procedure than transmastoid labyrinthectomy and has lower morbidity, but also has a lower success rate. It involves a transcanal approach, so it can be more difficult to remove all of the vestibular end organs, Dr. Miller said. This, she said, might be a better approach for older or frail patients. 

Pages: 1 2 3 4 | Single Page

Filed Under: Features, Home Slider Tagged With: Meniere's disease, Triological Society Combined Sections Meeting 2019Issue: March 2019

You Might Also Like:

  • Intratympanic Corticosteroid Treatment as Effective as Gentamicin for Ménière’s
  • AAO-HNS Updates Guidance on Ménière’s Disease Diagnosis, Treatment
  • Endolymphatic Shunt Surgery Comparable to Intratympanic Gentamicin in Controlling Vertigo in Ménière’s Disease
  • Are Diuretics Useful in the Treatment of Meniére’s Disease?

The Triological SocietyENTtoday is a publication of The Triological Society.

Polls

Do you use AI-powered scribes for documentation?

View Results

Loading ... Loading ...
  • Polls Archive

Top Articles for Residents

  • Applications Open for Resident Members of ENTtoday Edit Board
  • How To Provide Helpful Feedback To Residents
  • Call for Resident Bowl Questions
  • New Standardized Otolaryngology Curriculum Launching July 1 Should Be Valuable Resource For Physicians Around The World
  • Do Training Programs Give Otolaryngology Residents the Necessary Tools to Do Productive Research?
  • Popular this Week
  • Most Popular
  • Most Recent
    • How to: Positioning for Middle Cranial Fossa Repair of Superior Semicircular Canal Dehiscence

    • Endoscopic Ear Surgery: Advancements and Adoption Challenges 

    • The Dramatic Rise in Tongue Tie and Lip Tie Treatment

    • Rating Laryngopharyngeal Reflux Severity: How Do Two Common Instruments Compare?

    • Otolaryngologists Are Still Debating the Effectiveness of Tongue Tie Treatment

    • The Dramatic Rise in Tongue Tie and Lip Tie Treatment

    • Rating Laryngopharyngeal Reflux Severity: How Do Two Common Instruments Compare?

    • Is Middle Ear Pressure Affected by Continuous Positive Airway Pressure Use?

    • Otolaryngologists Are Still Debating the Effectiveness of Tongue Tie Treatment

    • Complications for When Physicians Change a Maiden Name

    • The Importance of Time Away
    • Endoscopic Ear Surgery: Advancements and Adoption Challenges 
    • Reflections from a Past President of the Triological Society
    • ENT Surgeons Explore the Benefits and Challenges of AI-Powered Scribes: Revolutionizing Documentation in Healthcare
    • How To: Open Expansion Laryngoplasty for Combined Glottic and Subglottic Stenosis

Follow Us

  • Contact Us
  • About Us
  • Advertise
  • The Triological Society
  • The Laryngoscope
  • Laryngoscope Investigative Otolaryngology
  • Privacy Policy
  • Terms of Use
  • Cookies

Wiley

Copyright © 2025 by John Wiley & Sons, Inc. All rights reserved, including rights for text and data mining and training of artificial technologies or similar technologies. ISSN 1559-4939