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7.6) Meniere's, Tinnitus, & Gentamicin, as explained by Jim Chinnis :




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This article is from the Tinnitus FAQ, by markb@cccd.edu (Mark Bixby) with numerous contributions by others.

7.6) Meniere's, Tinnitus, & Gentamicin, as explained by Jim Chinnis :

Originally, streptomycin was tried as a treatment for medically
intractable Meniere's (before considering surgical approaches).
As best I can determine, the technique was developed at Tulane
Univ by Charles Norris in the US and first tested by Dr. John
Shea Jr. in Memphis, Tennessee, USA. Doctors knew that
streptomycin could destroy hearing and balance. Early interest
was in seeing if the vestibular system could be suppressed with
small doses during space travel in order to reduce motion
sickness experienced by NASA astronauts.

Shea and others soon recognized that streptomycin could be used
in two ways for Meniere's. Either a large dose could be used to
chemically destroy the neural hair cells of the inner ear (giving
a result similar to nerve section, but without surgery) or a
carefully monitored dose could be used so that treatment would
stop as soon as any hearing or vestibular damage could be
measured. The latter idea was based on the thought that either
the vestibular signal could be weakened or even that the cells in
the vestibular (balance) system in the ear that were misfiring
and causing vertigo might be selectively destroyed with
streptomycin. It was also known that aminoglycosides had complex
activity within the tissues of the inner ear and had a particular
affinity for tissue believed responsible for the production of
endolymph. (Overproduction of endolymph or failure of resorption
is believed to be the principal cause of Meniere's symptoms and
the symptoms of some other inner ear problems, as well.) Dr. Shea
was somewhat successful in developing this treatment. It has been
tried now around the USA, in Italy, Australia, Canada, and
elsewhere in numerous variations but is not generally known to
practicing ENTs.

The newer form of the treatment is to use gentamycin instead of
streptomycin because it is safer. The drug is administered either
into the middle ear and allowed to perfuse through the round
window into the inner ear or given by (systemic) injection.
Patient goes home same day. Results have been very good as far as
I can tell. One large unilateral study (people with Meniere's in
one ear) showed the following results: vertigo gone in over 90%
of cases, tinnitus GONE in more than 80% of cases. Another large
study found vertigo gone in 85.5% of cases, improvement of
hearing of at least 10 db in 26.7%, disappearance of pressure or
fullness in 78.4%, and the disappearance of tinnitus in 51.6% of
cases and its significant reduction in another 24.2%.

Researchers (e.g., T. Sala in Italy) think that the gentamicin
permanently affects the"vascular stria" and the "dark cells" so
that less endolymph is produced and causes changes in a number of
cellular biochemical processes in the inner ear.

Of major importance to those with Meniere's affecting both ears
is the finding that the Meniere's may be "cured" by either
parenteral injections or middle ear applications. Sala cites four
additional references that report on treatment/cure of bilateral
Meniere's using streptomycin or gentamicin. He argues for
gentamicin, due to its greater affinity for tissues believed
responsible for endolymph production and because of its lower
toxicity. He argues also that the topical administration of
gentamicin can be used even when little or no hearing loss is
present, since the dosing can be stopped before significant
hearing loss occurs. Because the drug then (allegedly) results in
reduction of endolymph pressure, no further hearing loss or
vertigo attacks are expected. Thus gentamicin perfusion therapy
appears to be a viable treatment at any stage of Meniere's
unilateral or bilateral, and may preserve hearing and balance if
used soon enough.

Sala also argues that treatment with aminoglycosides could be
expected to be effective against tinnitus or balance disorders
due to any of a wide variety of causes, not just Meniere's. I
have not seen any research done on this assertion.

A finding of major importance is that when the earliest patients
from about 15 years ago are examined today, the improvements made
by the streptomycin therapy are still there, suggesting that the
treatment may be permanent.

Please note that if you seek this treatment or ask your doctor to
consider it you will probably have difficulty. S/he will probably
never have heard of it. I have a list of about six doctors in the
US who perform the treatment in at least some versions. There is
obviously Sala in Italy (Venice), and I have a lead to a doctor
in Australia and Canada.

This information is just my take on some fairly technical journal
articles. The opinions are those of medical doctors who wrote the
journal articles but the words are mine. I am not a medical
doctor, just a Meniere's patient like many of you.

References:

Dickens, John R.E., M.D., and Graham, Sharon S. (Meniere's
Disease--1983-1989). The American Journal of Otology, Vol. 11,
Number 1. January 1990.

Sala, T. (Transtympanic administration of aminoglycosides in
patients with Meniere's disease). Archives of
Oto-Rhino-Laryngology, 245:293-296. 1988.

Pyykko, I., Ishizaki, H., Kaasinen, S., Aalto, H. (Intratympanic
gentamicin in bilateral Meniere's disease). Otolaryngology--Head
& Neck Surgery, 110(2):162-167. Feb 1994.

Shea, J.J. Jr., and Ge, X. (Streptomycin perfusion of the
labyrinth through the round window plus intravenous
streptomycin). Otolaryngologic Clinics of North America,
27(2):317-24. April 1994.

 

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