Transtympanic gentamicin and fibrin tissue adhesive for treatment of unilateral Meniere's disease: Effects on vestibular function

OBJECTIVE: To determine the effects of transtympanic injections, with a mixture composed of gentamicin and fibrin tissue adhesive (FTA), on vestibular function of patients with intractable unilateral Meniere's disease. STUDY DESIGN: This was an open, prospective study. SETTING AND PATIENTS: The study was performed at 2 tertiary referral centers. Twenty-six patients affected by "definite" unilateral Meniere's disease, unresponsive to medical therapy for at least 6 months, were enrolled. INTERVENTION: A buffered gentamicin solution mixed with FTA was injected in the middle ear until the development of bedside vestibular hypofunction signs and/or caloric weakness in the treated ear. MAIN OUTCOME MEASURE: Vestibular function was evaluated by 3 bedside vestibular tests (observation of spontaneous nystagmus, head shaking test, and head thrust test) and by a caloric test. Tests were performed on days 10 and 30 after completion of treatment. Tests were also performed 3, 6, and 12 months from completion of the gentamicin-FrA protocol. The effects of treatment were also assessed in terms of hearing levels, control of vertigo, and disability status. RESULTS: In 22 of the 26 patients, only 1 gentamicin-FTA injection was necessary to obtain I or more signs indicating a reduction of the vestibular function in the treated ear. Four patients needed another treatment because of the persistence of their incapacitating symptoms during the follow-up. Four patients needed more than I injection to obtain a vestibular hypofunction. None of the patients who received I or 2 injections presented hearing loss in direct temporal relationship to the treatment. CONCLUSIONS: A mixture of gentamicin and fibrin glue makes it possible to considerably reduce the number of administrations in patients with intractable unilateral Meniere's disease. Spontaneous nystagmus, post head shaking nystagmus, and a head thrust sign are the clinical signs that indicate onset or progression of unilateral vestibular hypofunction. These signs were obtained with only 1 injection in 81% of patients.