Systematic review of intratympanic gentamicin in Meniere's disease

Objectives: To assess and summarize the best available evidence for the use of intratympanic gentamicin in patients with Meniere's disease with respect to improvement of vertigo, tinnitus, and change in hearing. Methods: Comprehensive electronic searches were conducted on the databases of MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials. All generated titles were reviewed, and potentially relevant articles were assessed for inclusion. Data from included articles were extracted and summarized. Results: Overall pooled results on vertigo control revealed complete or substantial control in 89% of patients (study range 73-100%). Hearing was worsened in 26% (0-90%). Subjective improvement in tinnitus was seen in 57% of patients (0-82%). Different treatment protocols all resulted in similar rates of vertigo control. Conclusions: Intratympanic gentamicin appears effective in controlling the symptoms of Meniere's disease, regardless of the protocol used. Although the literature on this treatment is extensive, there is a likelihood of significant bias in many cutrently published reports. There is a clear need for a prospective, randomized, blinded, placebo-controlled trial to assess the true effectiveness of this treatment.