A patient with definite Meniere's disease (fulfilling AAO-HNS 1995 criteria) has been treated with dietary salt restriction, diuretics and betahistine for 18 months but continues to have disabling vertigo attacks. The next most appropriate interventional option is:

• A Endolymphatic sac decompression
• B Vestibular nerve section
• C Intratympanic gentamicin injection ✓
• D Intratympanic dexamethasone injection

Explanation

In Meniere's disease refractory to medical therapy, the next step depends on the status of hearing. Intratympanic gentamicin (chemical labyrinthectomy) selectively ablates vestibular hair cells to stop vertigo attacks, at the cost of some cochlear toxicity. It is the minimally invasive option with the highest efficacy (>80–90%) for vertigo control. Intratympanic steroids are less effective for long-term vertigo control but preserve hearing. Endolymphatic sac decompression has modest evidence. Vestibular nerve section requires craniotomy and is considered if hearing is serviceable and less invasive options fail.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.