For Healthcare Professionals:
Background:
Meniere's disease is a chronic progressive inner ear disorder characterized by recurrent vertigo attacks, tinnitus, aural fullness, and fluctuating sensorineural hearing loss. For patients with therapy-refractory courses, transtympanic administration of gentamicin is considered as an ablative vestibulotoxic intervention.
Objective of the review:
A systematic review with meta-analysis evaluated the efficacy and safety of transtympanic gentamicin injections in Ménière’s disease, based exclusively on randomized controlled trials (RCTs).
Study design & methods
- Data base: 3 RCTs comparing gentamicin with placebo or no treatment
- Assessment system: GRADE for risk of bias and certainty of evidence
- Primary outcomes:
- Frequency and severity of vertigo attacks
- Quality of life
- Incidence of serious adverse events
Key results
- Dizziness attacks
All three RCTs showed significant reduction in frequency and intensity with gentamicin compared with control. - Quality of life:
Positive trends, but inconsistently assessed and difficult to compare. - Side effects:
Serious side effects were rare, but systematic assessment and long-term data were lacking. - Evidence quality:
Despite positive effects, overall certainty of evidence was rated very low , mainly due to small sample sizes and methodological inconsistencies.
Conclusion for Practice
Transtympanic gentamicin appears to be a promising option for vertigo reduction in therapy-resistant Ménière’s disease. However:
- The evidence base remains weak — no robust foundation for broad application.
- There is a clear need for larger, high-quality studies with standardized protocols, especially regarding dosing, frequency, and long-term safety.
👉 Want to deepen your knowledge of Ménière’s disease?
Current further education opportunities can be found in the IVRT Course search.
For Patients – Easy to Understand
Ménière’s disease: Can ear injections stop vertigo?
What is Ménière’s disease?
An inner ear condition that causes sudden vertigo attacks, ringing in the ear (tinnitus), pressure in the ear, and hearing loss. Symptoms often occur in episodes and can be very distressing.
One possible treatment: Gentamicin injections into the ear
→ Gentamicin is an antibiotic, but here it is used not for its antibacterial effect. Instead, it is injected through the eardrum directly into the inner ear.
→ It targets specific sensory cells in the balance organ. Normally, these cells detect motion. In Meniere's disease , they can send false signals, causing severe vertigo.
→ By partially disabling these cells, gentamicincan reduce or even stop vertigo attacks.
What does the new review say?
A Danish research team analyzed three high-quality studies (published 2025).
Main findings:
- Less dizziness:
Many treated patients had fewer and milder attacks. - Better quality of life:
Some reported meaningful improvement in daily life. - But: The studies were small, and the evidence is not yet strong enough for clear recommendations.
Is this suitable for me?
This treatment may be an option if other measures fail. Still, keep in mind:
- It can in rare cases sometimes affect hearing.
- The effect is not the same for everyone.
- Careful medical evaluation is essential.
Conclusion
- Gentamicin injections may offer relief for patients with severe vertigo.
- The scientific evidence is promising, but still too limited for general use.
- Always seek thorough medical advice before deciding.
👩⚕️ You are considering a gentamicin therapy?
Gentamicin can also weaken the balance organ - this is called a vestibular hypofunction.
This weakening occurs because sensory cells in the inner ear are partially deactivated by the medication. In everyday life, this can lead to new challenges—for example, when walking in the dark, on uneven ground, or during rapid head movements.
➡️ The good news: These problems can be effectively improved with vestibular rehabilitation therapy verbessern.
🎯 Specially trained IVRT® dizziness and vestibular therapists can be found via our IVRT therapist search