In extremely severe cases, treatments that deaden the inner ear such as gentamicin injections or surgery may be considered. This is a last resort for persons who have severe attacks which are disabling. At present, we favor gentamicin for most instances where destructive treatments are being considered. Injections of gentamicin are given through the ear drum, through a small hole or through a small tube. This procedure allows the doctor to treat one side alone, without affecting the other. Typically, about four injections are given over a period of one month. Some authors have reported improvements in 60 to 90 percent of patients with gentamicin (Driscoll et al., 2009; Bodmer, 2007; Boleas-Aguirre, 2007; Chung, 2007), and Chung reported equally effective results with a single injection compared to multiple injections (Chung, 2007). Dizziness may reoccur one year later, requiring another series. Gentamicin injection can also result in hearing loss (Silvertein 2009; Colletti, 2007).
MD is very unpredictaable at times, but I manage as best I can. One reference that has been helpful in the book "Meniere's Disease: What You Need To Know" by PJ Haybach, RN, MS available through the VEDA website (Vestibular Disorders Association) in the US. It helped me a great deal in the early times getting used to the idea of managing MD-handy strategies like keeping needed supplied in reach in the bathroom "just in case". Those were also the days I decided to get my first cell phone to avoid being caught on either a very hot day or a cold winter night alone without help.
In some instances, your specialist may recommend that you undergo an injection of gentamicin into the middle ear instead of a steroid. Gentamicin is an antibiotic which is known to have mildly toxic effects on both the balance and hearing parts of the ear, although its toxic effects on the vestibular system are very much more potent than on the hearing. Despite this, there is an increased chance of a hearing loss occurring with intratympanic gentamicin injections. For this reason, they are usually reserved for patients with a pre-existing severe hearing loss at the time the vertigo is diagnosed.