Exploratory tympanotomy and gentamicin application in patients with intractable Meniere's Disease

Intractable disease is reported by 10%-15% of patients with vertigo, even after medical treatment and an intratympanic injection of gentamicin. In these cases, the therapeutic options are definitive ablative procedures, such as vestibular neurectomy or labyrinthectomy. However, both procedures are inevitably accompanied by surgical morbidity. Exploratory tympanotomy with gentamicin application has been suggested as a reasonable intermediate surgical option before attempting definitive ablative procedures. This procedure can eradicate intratympanic anatomical problems that might interrupt gentamicin delivery into the inner ear and enables confirmation of the prolonged and direct contact of the drug with the oval window and the round window membrane. In our case series analysis, out of 94 patients who received intratympanic gentamicin injection, 10 patients (10.5%) could not reach class A or class B. Among them, 7 patients underwent exploratory tympanotomy and gentamicin application, and complete control of vertigo (class A) was achieved in 5 patients (71%). With the advantage of its minimal surgical burden, exploratory tympanotomy and gentamicin application may be a reasonable surgical option before considering definitive ablative procedures.