Transtympanic Gentamicin vs. Steroids in Refractory Meniere's Disease

Inclusion Criteria:

• Patients with unilateral Ménière's disease (definite or probable, according toCommittee on Hearing and Equilibrium guidelines, 1995) with hearing loss andpresenting with recurrent vertigo, not responding to medical treatment for at least 6months will be included. There should be normal, age appropriate hearing in thecontralateral ear.

Exclusion Criteria:

• Patients with Ménière's disease in later stages (not having vertigo attacks).

• Age: patients older than 70 years at the start of the trial.

• Severe disability (e.g. neurological, orthopaedic, cardiovascular) or seriousconcurrent illness that might interfere with treatment or follow up.

• Active additional neuro-otological disorders that may mimic Ménière's disease (e.g.vestibular migraine, vertebro-basilar TIAs, acoustic neuroma) and thus will make theobjective follow up difficult.

• Concurrent ear pathology that may interfere with transtympanic treatment (e.g. activemiddle ear disease).

• Family history of unexplained deafness (possibility of genetic susceptibility togentamicin toxicity).

• History of known adverse/allergic reaction to steroids or gentamicin.