A systematic review and meta-analysis of intratympanic gentamicin for patients with Ménières disease

Ménière’s disease is a chronic inner ear disorder characterized by recurrent vertigo, tinnitus, aural fullness, and fluctuating sensorineural hearing loss. For patients with debilitating symptoms unresponsive to conservative treatment, intratympanic gentamicin is a therapeutic option. However, its efficacy and safety remain uncertain. This systematic review aims to evaluate the effectiveness and safety of intratympanic gentamicin in Ménière’s disease, focusing exclusively on randomized controlled trials (RCTs). A comprehensive literature search was conducted to identify RCTs comparing intratympanic gentamicin with placebo or no treatment. Primary outcomes included vertigo frequency and severity, quality of life, and incidence of serious adverse events. Data were analyzed using the GRADE approach to assess risk of bias and certainty of evidence. Three RCTs were included, demonstrating a significant reduction in vertigo frequency and severity in patients treated with intratympanic gentamicin compared to placebo. However, the evidence quality was rated very low due to small sample sizes and methodological limitations. Findings suggest that intratympanic gentamicin may reduce vertigo in Ménière’s disease. However, due to the limited certainty of the evidence, further research with larger sample sizes and standardized outcome measures is necessary to clarify its benefits and risks.