Can medications affect the function of the vestibular labyrinth?
A patient having an acute attack of vertigo, nausea, and vomiting, suggesting the onset of labyrinthitis or vestibular neuronitis, may be treated palliatively with promethazine or prochlorperazine for nausea/vomiting (many patients may not be able to tolerate oral medications at this stage so suppositories may be necessary) and with steroids, such as prednisone, dexamethasone, or methylprednisolone, to reduce inflammation.
Pharmacologic intervention for Ménière’s disease (endolymphatic hydrops) is initially vestibular suppressant medications such as the antihistamine meclizine or the benzodiazepine lorazepam.
If those medications are ineffective the use of diuretics may reduce fluid fluctuations in the inner ear.
For example, medications such as hydrochlorothiazide may be tried.
Some medications such as the antineoplastic cisplatin, and aminoglycoside antibiotics, notably gentamicin, are highly toxic to hair cells.
Large doses of either drug will cause permanent damage to hair cells and, therefore, permanent bilateral vestibular and hearing losses.
Therefore, intratympanic gentamicin is used as a last-resort treatment for Ménière’s disease, when destroying vestibular function on one side may be therapeutic to help the patient overcome debilitating attacks of vertigo that do not respond to pharmacologic intervention.
