[Transtympanic gentamicin in Ménière's disease: evaluation of the quality of life].

Different methods have been proposed for the management of intractable Ménière's disease. Over the past years a selection has been made based on the effectiveness and the side effects of the surgical techniques and only a few procedures are routinely used in modern practice. After a period of success, endolymphatic sac surgery is now being progressively abandoned in the aftermath of criticism on its real effectiveness. Vestibular neurectomy is considered an effective method for relieving vertigo but it is an invasive procedure and the risk of complications is not absent. Transtympanic gentamicin is now considered a real alternative approach to the treatment of vertigo in Ménière's disease. The literature reports a high incidence of success with this method, similar to that of vestibular neurectomy, and the only complication being some hearing loss encountered in a few cases. Strategies differ in the gentamicin treatment of Ménière's disease. In the past gentamicin was administered on a daily basis until an effect on the labyrinth was seen. Recently some authors have administered lower amounts of gentamicin for just two or there days. Such treatment appears to control vertigo equally well without causing labyrinthine areflexia although this is not supported in the literature by prolonged follow-ups. The authors discuss the results obtained with a low dosage transtympanic administration of gentamicin in a series of 29 patients followed up for two years. The impact of this form of therapy on quality of life was evaluated through a questionnaire prepared following the criteria of the American Academy of Otolaryngology Head and Neck Surgery. In all cases, the score improved at the end of follow-up.