A patient meets the 2015 Barany Society criteria for definite Meniere's disease. Which intervention is considered the most evidence-based ablative procedure for refractory Meniere's disease that preserves hearing?

• A Labyrinthectomy
• B Vestibular nerve section (singular neurectomy or posterior ampullary nerve section)
• C Cochleosacculotomy
• D Intratympanic gentamicin (chemical labyrinthectomy) ✓

Explanation

Intratympanic gentamicin (transtympanic aminoglycoside) preferentially ablates vestibular hair cells (which are more sensitive to aminoglycosides than cochlear hair cells when given in low doses with titration protocols) while partially preserving hearing. It is the most widely used ablative intervention for refractory Meniere's disease due to its minimally invasive nature and good vertigo control rates (~80–90%). Labyrinthectomy destroys all labyrinthine function including hearing and is reserved for non-serviceable hearing ears. Vestibular nerve section requires posterior fossa neurosurgery. Endolymphatic sac procedures are non-ablative.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.