From the Guidelines
Intratympanic gentamicin injections are a safe and effective treatment option for patients with unilateral Meniere's disease who have failed more conservative therapies, with a significant reduction in vertigo complaints and a low incidence of severe hearing loss, as supported by recent studies 1. For patients with Meniere's disease, intratympanic gentamicin injections can be an effective treatment for managing vertigo symptoms. The evidence suggests that gentamicin injections can decrease vertigo symptoms in patients with Meniere's disease, with an estimated complete vertigo control rate of 73.6% reported in a systematic review 1. Some key points to consider when using intratympanic gentamicin injections for Meniere's disease include:
- The delivery method, with intratympanic injections being the most common method reported in the literature 1
- The dosage, with titration therapy showing improved control of vertigo in 81.7% of patients, and weekly titration having less overall hearing loss compared to other methods 1
- The potential risks, including hearing loss, with an average increase in hearing loss of 18.1 dB in the gentamicin group, and the need to assess the vestibular status of the other ear before recommending treatment with gentamicin to avoid potential bilateral hypofunction 1 It is essential to note that intratympanic gentamicin injections are generally reserved for patients who have failed more conservative therapies, and a proper diagnosis is necessary before considering this treatment option. Additionally, patients with bilateral Meniere's disease should be cautioned about the risk of significant bilateral vestibular hypofunction and rare hearing loss. In terms of other treatment options for vertigo, some medications can be given by injection to help manage certain causes of dizziness in specific situations, such as intramuscular or intravenous antihistamines for acute severe vertigo, or corticosteroid injections for vestibular neuritis or labyrinthitis. However, most dizziness is managed with oral medications or other treatments rather than injections, and the appropriate treatment depends on the underlying cause of dizziness.
From the Research
Treatment Options for Vertigo
- The treatment of vertigo depends on the specific etiology, which can be peripheral, central, or psychogenic 2.
- Medications with different mechanisms of action, physical therapy, psychotherapy, and surgery may be used to treat vertigo, depending on the cause 2, 3.
- Symptomatic treatment has a particularly important role, regardless of the etiology of vertigo 2.
Pharmacological Treatment
- Classes of medications useful in the treatment of vertigo include anticholinergics, antihistamines, benzodiazepines, calcium channel antagonists, and dopamine receptor antagonists 3.
- These medications may modify the intensity of symptoms or affect the underlying disease process 3.
- Vestibular suppressants, such as anticholinergics and benzodiazepines, are used to treat otological vertigo, including disorders such as Ménière's disease and vestibular neuritis 3.
Surgical Treatment
- Surgery for vertigo is recommended where there is objective evidence of a unilateral inner ear disorder, when medical therapy fails, and when the patient demands definitive therapy 4.
- Common surgical procedures include the endolymphatic subarachnoid shunt, retrolabyrinthine vestibular neurectomy, cochleovestibular neurectomy, and the post ampullary nerve section (singular neurectomy) 4.
- Vertiginous disorders that can be surgically cured include Ménière's disease, vestibular neuronitis, chronic labyrinthitis, and benign positional vertigo 4.