Transtympanic Gentamicin

                This form of treatment involves the injection of medication through the eardrum into the middle ear.  The medication, which is then taken up by the inner ear, destroys the hair cells of the inner ear.  The medication, Gentamicin, is an antibiotic which also is toxic to the hair cells of the hearing and balance organ.  The idea is to destroy enough of the hair cells to eliminate the vertigo.

                There are advantages and disadvantages of this form of treatment.  The attractive feature is that surgery is not required.  One of the downsides of this treatment is the potential for hearing loss.  There is a 30% risk of mild reduction in hearing.  Gentamicin is toxic to hair cells of both the hearing and balance organs and once the medicine reaches the middle ear, absorption into the inner ear is uncontrolled and variable.  Multiple injections may be required in order to achieve the desired effect.

                Gentamicin prefusion can be performed in the office under local anesthesia and it effectively decreases vestibular function in the treated ear in approximately 80 to 85% of patients.  In these cases, patients either have no vertigo episodes or very mild ones.