Tympanic Gentamycin Therapy is an option for some patients with severe dizziness.  The antibiotic Gentamycin is toxic to the ear in high doses.  This property can be used to advantage in some patients experiencing dizziness from Meniere's Disease or other ear disorders causing vertigo and dizziness. 
 
The inner ear has tens of thousands of 'hair cells' which are the nerve endings sensitive to sound and motion.  Gentamycin can damage these hair cells.  The vestibular (balance) hair cells are much more sensitive to Gentamycin than are the hearing hair cells.  By careful application, this drug can destroy the vestibular hair cells without causing hearing loss. 
 
In Meniere's Disease the ear has lost its ability to regulate inner ear fluids.  This causes dizzy spells with fluctuations in hearing and tinnitus (ringing in the ear).  Meniere's Disease can cause severe dizziness interfering with normal life, and putting the patient at risk of falling or accidents when operating machinery, driving, etc.  The vestibular hair cells of the involved ear provide no reliable balance information, and cause dizziness and vertigo with each attack.  Destroying these hair cells prevents future dizzy spells, and actually improves balance.  Gentamycin can be used to do this. 
 
Tympanic injection of Gentamycin is done in the office and hurts about as much as collecting a blood sample.  The ear is examined with a microscope, and a drop of anesthetic numbs the eardrum.  Then a tiny needle is used for the injection.  The patient remains laying for about half an hour after the injection.  This is repeated weekly until dizziness stops.  Hearing is checked before each injection.  As most patients require 5 or 6 injections, a tube may be placed in the eardrum. 
 
Some degree of dizziness is to be expected during the course of the Gentamycin therapy, usually less severe than the patient's typical dizzy spells.  The risk of hearing loss is low.  The ear must be kept dry during the course of injections. 
 
What are the alternatives?  Standard medical treatment with diuretics, or vestibular suppressants must fail before considering this treatment.  Patients who have no usable hearing in the involved ear have the option of surgical destruction of the ear (Labyrinthectomy) with excellent results.  If hearing is good, this is not an option.  A vestibular neurectomy, or an endolymphatic sac shunt are operations designed to stop dizziness without damaging hearing.  Both of these involve the risks and discomfort of ear surgery.  It would be possible to proceed with any of these operations if for some reason Gentamycin therapy was not completely successful.