Gentamicin

Gentamicin (gentamycin) is an antibiotic injected into the middle ear by an otologist in order to destroy the vestibular hair cells that mediate the recurrent vertigo symptoms of Ménière's disease.

General steps taken at Sunnybrook while administering gentamicin

1. The afflicted ear is identified
   
   
2. A myringotomy (incision on ear drum) is performed under local anaesthesia
   
   
3. A butterfly T-tube assembly is inserting through the myringotomy (see picture below for individual parts and for final assembled apparatus). The assembly is then secured in the ear canal and tubing on the neck to prevent movement of the tube.
   
   
4. The first injection is given using gentamicin (40mg/cc - buffered in bicarbonate solution to 26.7 mg/cc)
   
   
5. The patient is sent home and instructed to administer 11 more gentamicin injections over a period of four days. See the patient instruction guide below for proper care and administration of the injections.

Homecare guidelines for patients receiving gentamicin treatment

1. Keep the syringes in the refrigerator. Take one syringe out of the refrigerator half an hour before injection.
   
   
2. On your first day, you may experience some ear discomfort. Throughout the week you may experience some burning when the injection is administered. You may take Tylenol® at any time (two tablets every 4-6 hours when necessary).
   
   
3. To sleep you will be most comfortable lying on the unaffected side or your back.
   
   
4. Before each injection, use the empty syringe given to you to draw out what is left in the tubing from the previous injection. You will get a small amount of clear, yellow, or red-tinged fluid. Discard the fluid into a sink. Keep the syringe from the next fresh injection for withdrawing prior to the following injection.
   
   
5. Slowly, over a period of about one minute, inject the fresh solution into the middle ear through the tubing placed by the doctor.
   
   
6. Lay on the unaffected ear for half an hour after injection. If any fluid runs into your mouth or you have a bad taste, spit it out. Do not swallow it.
   
   
7. Some injection may run out of the ear beyond the tape; this is normal.
   
   
8. When you come back to see your doctor, bring the case and used syringes. The nurse will refill your case for home.
   
   
9. If you experience severe dizziness and/or spinning, do not administer the next dose. Wait until your next visit to your doctor.
   
   
10. To voice any other concerns or questions during this week, contact the otolaryngology (ENT) clinic at 416-480-4138.
    
    
11. There is a cost for drugs and disposables for this treatment.