Gentamicin Treatment for Meniere’s Disease—Here’s the Scoop
by Neil Bauman, Ph.D.
A lady wrote:
Dr. Timothy Hain has written an article about low-dose Gentamicin treatment. What do you have to say about this treatment?
I respect Dr. Hain and his work, although, in my opinion, he is too conservative when it comes to the side effects of ototoxic drugs. By this I mean that he doesn’t think the ototoxic side effects are as common and severe as they really are.
Gentamicin, as a treatment for Meniere’s disease, has been around for quite a while. As the above article explains, in the past, high-dosage Gentamicin treatments have resulted in pretty significant ear problems including hearing loss.
This new low-dose protocol seems to cause far less damage to the inner ear than the high-dose one, and that is all to the good.
However, there are a few things this article doesn’t mention of which I think anyone contemplating this procedure should be aware.
First, a significant portion of the population have a genetic variant that leaves them very susceptible to aminoglycoside ototoxicity—much more so than the general population. Since Gentamicin is one of the aminoglycosides, it would seem wise to be tested to see if you have the 1555A-G variant of the 12S rRNA gene (see page 109 in my book “Ototoxic Drugs Exposed for more information), and if you have it, really consider whether the supposed benefit will be worth the greatly increased risk.
Second, this treatment can work great and “kill” the balance system in one ear, hopefully eliminating the severe vertigo. But what happens if later your Meniere’s switches to your other ear, as it does in approximately 20% to 25% of the people with Meniere’s?
With your balance system dead in one ear, you don’t dare do the same procedure on your other ear, or you will be left without any inner ear balance function at all. Among other balance problems, this will almost certainly result in such conditions as oscillopsia (bouncing vision), ataxia (staggering gait like you were drunk), blurred vision and other problems with your eyes. If this happens to you, you will never be able to drive again. You will likely find movement such as riding in a car, or even just watching action movies on your TV can make you “sick”.
Third, there are no guarantees that even in low doses, the Gentamicin will not affect your hearing. Gentamicin typically damages the balance system (a good thing in this case) more than it damages the hearing system (a bad thing)—but this is not always the case. Are you prepared to lose some or all of your remaining hearing in that ear? It can and does happen.
If you have severe vertigo with your Meniere’s, (and I can’t even imagine what that must be like) and nothing else works, you may want to try this treatment. Remember, this is a treatment of “last resort”—one not to be taken lightly.
If you have considered the above points, read the above referenced article carefully, done your own research and talked it over with your ear doctor, you are ready to make an informed choice. What you choose is up to you.
To learn more about Meniere’s Disease and some of the things you can do to help bring it under control, check out “Please Make My World Stop Spinning—The Agony of Meniere’s Disease“.
June 5th, 2009 at 4:40 pm
Although results vary from one person to another, the gent injections worked for me with no hearing loss. But you do make a good point about the meniere’s going from one to ear to the other.
April 13th, 2011 at 11:52 am
I started having drop attacks with my menieres in my right ear and just couldn’t go on, so finally my Dr would do the Gentamicin injections. Over 2 or more years I had 4 injections and did not lose hearing, but then after 10 years I got menieres in my other ear. I agree with the above article. I thought I could get the injections in my left but my Dr said NO WAY! I never regret getting the injections, infact the ear I hear best out of is the right (injection ear) and I wear hearing aides now. I sometimes have a hard time when some one else is driving and turns a corner too fast, never had that before and can not watch some movies. I never regret getting the injection but my prayer is that I don’t get any worse.
April 15th, 2011 at 12:32 pm
I underwent the gentamicin drops treatment for one week in my left ear for Meniere’s Disease and if my doctor had explained to me the possible effects of such a treament I NEVER WOULD HAVE DONE THIS!!!!! I pray everyday with every step I take that I will not fall down. The wick was inserted in my ear on March 28, 2011 and I realize that was only about three weeks ago but doctors need to communicate very clearly what may or may not be a result of this treatment. My husband and I assumed that it wasn’t a big deal because the only thing my ENT said to us was that I may not be able to drive for a little while and I might lose some hearing. Well, that was an understatement. He failed to mention (as a matter of fact he never mentioned, his nurse explained to me over the phone 10 days post-op) that imbalance, ataxia and exhaustion from the intense concentration it takes just to put one foot in front of the other could take weeks to months to get better and that I will never be able to walk in the dark again because I will fall down. This has put my life at an almost complete halt for how long…I don’t know!!!
IF ANYONE READS THIS AND IT HELPS JUST ONE PERSON TO RECONSIDER OR THINK TWICE BEFORE UNDERGOING THIS TREATMENT THEN AT LEAST I WON’T FEEL LIKE MY SUFFERING AND MISERY IS IN VAIN!!! PLEASE MAKE YOUR DOCTOR COMMUNICATE WITH YOU AND DON’T JUST ASSUME ITS NO BIG DEAL BECAUSE HE/SHE SAYS SO!!! ITS NOT THEIR BALANCE SYSTEM THAT’S GOING TO BE DESTROYED…ITS YOURS!!!
November 16th, 2011 at 10:24 am
I had the high-dose trans-tympanic gentamycin injection maybe four or five years ago, because I was getting spinning vertigo/vomiting hell on earth attacks 3 or 4 times a month, and tried the low-sodium diet, diuretics, oral prednisone and trans-tympanic decadron injection, all to no avail. I lost the hearing in my left ear, but the vertigo attacks STOPPED COMPLETELY! Yes, I now have hearing loss sufficient to be categorized as severe to profound, and the ear is un-aidable. For a while I did fine, but then vestibular dysfunction manifesting as gait disturbance that looked alarmingly like upper motor neuron disease and Parkinson’s at times. After visiting a top neurologist in Columbia University with a specialty in Parkinson’s, I was told that I did not have it, or any other similar disease. However, she did remark that I would probably benefit from vestibular rehabilitation, which I went to for a while. Then, a light bulb went on, and I realized that it was likely that some of the hair cells killed by the first gentamycin injection must have arisen from the grave, so I went to the same otoneurologist that did the first one, had a second one, and have been free of vestibular symptoms since.
Of course, there is always the downside of the hearing loss, but I felt it was a fair trade for my safety (God forbid you ever get an attack while driving!). The other, later downside is that the beginning symptoms of Meniere’s are now appearing in my right ear, with fluctuating hearing loss and sense of “aural fullness” or pressure, accompanied by occasional pulsatile tinnitus. I have yet to, and hope not to experience the ringing tinnitus and vertiginous symptoms in that ear, but if I do, I will be in pretty big trouble until something to correct it is discovered. I no longer have the option of the gentamycin, and even another decadron injection is not without risk to my remaining hearing. I am currently doing the tapered oral prednisone dose, hoping it works this time. If not, then I guess I will just have to wait and see if it progresses to full-blown Meniere’s, which will turn my life into a living hell if I can’t treat it successfully. Guess I will give the low-sodium diet another shot, but diuretics are out of the question for other medical reasons.
I’m not posting this as a cautionary tale, trying to warn others off the gentamycin, but merely as informational. I would still have done the gentamycin, even knowing what I know now, just for the peace of mind and freedom it returned to me. There’s no describing how horrifying a full-blown Meniere’s attack can be, but suffice to say, you won’t feel like doing anything at all for the next day or two after each attack. Couple that with the fact that I am on anti-coagulation therapy, and falling down can be very, very dangerous, possibly fatal for me. The potential for this to become yet another “Sword of Damocles” for me is serious, but I still hold out hope. That’s all I can do.
April 21st, 2012 at 10:27 pm
I have been battling with Meniere’s Disease for years and have constant tinnitis in the left ear. In December 2010, I had a stint put in and did very well for a year. In the past 2 months, I have had numerous attacks and this last week for 3 days I just went from one into another all day long. SO violent and right now they changed my water pill and uped my meds and want me to do the gentamycin shots and I must admit I am skeptical. Wondering if I had the surgery and they cut the nerve if it would end the violent attacks.. My balance is horrible and I can’ watch any spinning or moving and must be careful drving and I do not drive out of town…Confused in Montana
April 21st, 2012 at 10:55 pm
Hi Karen:
The Gentamicin shots would be less radical than having surgery to cut the nerve. Therefore, it would be a better choice to try first. If they can do it right–just enough to stop the vertigo–but not so much that it totally kills your balance or seriously affects your hearing, that would be a decided blessing. I assume you have tried everything else and nothing works for you anymore?
Regards
Neil