Intratympanic Medication
Patients who do not respond well to the previously described management should be referred to a specialist for additional treatment options. An otolaryngology specialist may administer intratympanic medications to patients with Ménière's disease who have not responded to primary medical therapy.
Patients in the US who have not responded positively to lifestyle or diuretic medication are commonly offered treatment with intratympanic dexamethasone. The primary goal of this therapy is to improve vertigo without affecting a patient's hearing; an added effect maybe a potential positive impact on the immune system. Studies show that intratympanic steroid injection results in control of vertigo in patients with Ménière's disease, but up to four injection treatments maybe required for optimal effectiveness. Improvement of vertigo is achieved in more than 80% of patients who undergo intratympanic steroid injections.
An option reserved for patients with severe, frequent vertigo related to Ménière's disease is a type of chemical ablation of the labyrinth induced by injecting gentamicin into the middle ear. Gentamicin has a toxic effect on the vestibular hair cells in the inner ear, resulting in elimination of vestibular function. Intratympanic gentamicin is reported to reduce symptoms from Ménière's disease, but this treatment is only recommended for patients with unilateral disease because it may induce permanent hearing loss.
The primary care clinician needs to be aware of these intratympanic procedures and encourage patients to follow up with the specialist if additional treatments are indicated.