Total Vestibular Ablation and VEMPs after Intratympanic Gentamicine in Patients with Intractable Vertigo

Objectives:Even today, treatment of intractable vertigo remains a challenge. The objective of this study was to control intractable vertigo through complete vestibular ablation with intratympanic gentamicin treatment. Complete vestibular ablation was confirmed by zero response on ice water (ENG) and an absent response on vestibular evoked myogenic potentials (VEMPs).Methods:Retrospective case study design in a tertiary care center. Subjects were patients with refractory episodic vertigo. The inclusion criteria were unilateral ear disease, moderate to profound sensorineural hearing loss, and failure to respond to other treatments. Included patients underwent 0.5‐0.8 mL of gentamicin intratympanic application at a 30 mg/mL concentration. Audiometry, electronystagmography with ice water, and vestibular evoked myogenic potentials were performed in all patients. Outcome measurements: VEMPs response and vertigo control.Results:Ten patients were included; 9 patients with Ménière's disease and 1 patient with delayed endolymphatic hydrops. Nine patients showed an absent response on VEMPs. The only patient with low amplitude on VEMPs had vertigo recurrence. Vertigo control was achieved in 90% of the patients. One patient developed hearing loss >30 dB.Conclusions:VEMPs confirmed complete vestibular ablation. High‐grade vertigo control was due to total vestibular ablation.