Does intratympanic gentamicin application in M. Ménière’s disease worsen speech recognition with cochlear implant?

Introduction In recalcitrant Ménière’s disease is drug-induced labyrinth ablation with intratympanic applied gentamicin (IGA) a therapeutic option. The vestibulotoxic effect of amioglycosides is accompanied by an ototoxic effect in about 20% of the patients. Animal testing results additionally suggest a neurotoxic effect that could impair hearing outcome after rehabilitation of hearing with CI.

Material/Methods 29 M. Ménière’s disease patients fitted with cochlear implants were retrospectively analyzed in regard to their hearing outcomes and speech recognition was compared between patients with or without gentamicin pretreatment. Data were statistically analyzed in R.

Results Pretreatment for Meniere’s disease was IGA in 8 patients, initial IGA followed by surgery in 4 patients (3 x labyrinthectomy, 1 x saccotomy), surgical therapy alone (5 x saccotomy, 1 x labyrinthectomy), and no invasive therapy in 12 patients. There was a similar distribution between groups in terms of age, gender, and CI manufacturer (Advanced bionics, MedEl, and Cochlear). Mean monosyllable speech perception at 65 dB with CI on most recent follow up presentation was significantly worse in gentamicin treated groups than in the groups without gentamicin therapy: gentamicin 56.9%, gentamicin+OP 41%, no invasive therapy 69.5%, surgery only 75.8%.

Discussion and Conclusion The poorer speech recognition of CI patients after IGA may partially be caused by a direct neurotoxic effect of gentamicin, which as has been suggested in animal tests. Until final clarification with a large patient collective, gentamicin therapy should be avoided to ensure optimal subsequent CI fitting.

Publication History

Article published online:
12 May 2023