Endolymphatic duct blockage versus intratympanic gentamicin for refractory Ménière’s disease

Background The goal of Ménière’s disease management is to control vertigo while minimizing adverse effects. Although intratympanic gentamicin(ITG) is effective, its vestibulotoxic and cochleotoxic potential remains a concern.Objective To compare ITG and endolymphatic duct blockage(EDB) in terms of vertigo control, hearing preservation, and vestibular function.Methods This retrospective comparative study included patients treated with either ITG or EDB. Audiometric assessments and caloric testing were analyzed before and after treatment.Results Fifty-two patients underwent EDB. 46 received ITG. Between 6 and 12 months post-treatment, the mean number of vertigo attacks was significantly lower in the EDB group than in the ITG group (0.12 ± 0.09 vs. 0.42 ± 0.22; p = 0.032). At 24 months, effective vertigo control (Class A or B) was comparable between groups, reaching 96.2% with EDB and 97.9% with ITG (p = 0.68). EDB was associated with better control of tinnitus (p = 0.03) and aural fullness (p = 0.009). Mean vestibular paresis was significantly lower in the EDB group than in the ITG group at 12 months (52.02% vs. 80.20%; p < 0.001). No, statistically significant changes in hearing thresholds were observed within either group at 24 months.Conclusion EDB and ITG provided effective long-term vertigo control. EDB was associated with better vestibular preservation and greater improvement in tinnitus and aural fullness.