الفهرس 
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Abstract
Meniere’s disease is an inner ear disorder marked by spontaneous attacks of vertigo, fluctuating sensorineural hearing loss, aural fullness, and tinnitus. Episodic vertigo and hearing loss are two of the most disabling symptoms that are associated with Meniere’s disease. These can be controlled in the majority of patients with medical management, consisting of a combination of low-salt diet and diuretics Surgical therapies have been offered to medically refractory patients, although intratympanic gentamicin has had increased use since the 1990s as an alternative treatment for these patients. Schuknecht introduced intratympanic aminoglycoside vestibular ablation in 1956. Recently, intratympanic gentamicin administration for treatment of Meniere’s disease has gained widespread popularity Potential advantages of intratympanic perfusion include: higher concentration of medication given in the inner ear, the diseased ear is treated directly without affecting the other ear or other organ systems, and potential side effects to the rest of the body are avoided. several advantages over surgical procedures. It is performed as an office procedure and eliminates the risks inherent with general anesthesia. Intratympanic gentamicin injections also eliminate the risk of meningitis, facial nerve injury, and CSF leak that is associated with some of the surgical operations. Intratympanic gentamicin techniques include 1-Direct injection through the tympanic membrane into the middle ear space. 2- placement of a ventilation tube with instillation of gentamicin through the tube (with or without a wick)3-through an indwelling catheter inserted into the middle ear space and placed in the round window niche. 4-use of minipumps and osmotic pumps to deliver continuous doses of gentamicin to the round window through an indwelling catheter in the middle ear. The success of therapy appears to be unaffected by the delivery route.There are five methods for intratympanic injection:1)multiple daily dosing (three doses daily for 4 days) 2) weekly administration for four total doses.3) low dose therapy consisting of one to two injections with repeat treatment only for recurrent vertigo. 4) continuous microcatheter delivery. ) titration of therapy to the onset of inner ear disturbance (daily or weekly doses until the onset of spontaneous nystagmus, change in vertigo symptoms, or hearing los The different tech¬niques of gentamicin administration for treatment of Meniere’s disease were compared to determine which treatment would provide the greatest amount of vertigo control and the lowest rate of hearing loss. The best method is titration method good vertigo control and less hearing loss in comparison to the different methods.