Understanding Vertigo and Its Causes
Vertigo is a sensation of spinning or dizziness, a symptom that can stem from various conditions affecting the inner ear's vestibular system, which controls balance [1.9.3]. While many experience fleeting dizziness, for some it becomes a chronic and debilitating issue. The lifetime prevalence of vertigo is estimated to be between 3% and 10% [1.9.2]. Common causes include Benign Paroxysmal Positional Vertigo (BPPV), Meniere's disease, and vestibular neuritis [1.5.3, 1.10.2]. Meniere's disease, in particular, is characterized by episodes of vertigo, hearing loss, tinnitus, and a feeling of fullness in the ear [1.3.2]. While lifestyle changes and oral medications are first-line treatments, some patients with intractable vertigo may require more direct interventions, such as injections into the middle ear [1.6.3].
Intratympanic Injections: A Targeted Approach
For persistent vertigo that doesn't respond to other treatments, doctors may recommend intratympanic injections. This procedure involves injecting medication through the tympanic membrane (eardrum) into the middle ear space [1.4.1]. The medication is then absorbed by the inner ear through a small, permeable opening called the round window [1.4.1, 1.4.5]. This method delivers a high concentration of the drug directly to the source of the problem, minimizing the systemic side effects that can occur with oral medications [1.3.4, 1.7.2]. The procedure is typically performed in a doctor's office under local anesthesia and takes only a few minutes [1.4.1]. The two main types of medications used are corticosteroids and the antibiotic gentamicin [1.2.1].
Types of Injections for Vertigo
Corticosteroid Injections (Dexamethasone, Methylprednisolone)
Corticosteroids, such as dexamethasone and methylprednisolone, are powerful anti-inflammatory drugs [1.4.5]. Their exact mechanism in treating vertigo isn't fully understood, but it's believed to involve reducing inflammation and regulating fluid pressure within the inner ear [1.3.5]. Intratympanic steroid injections are often considered a second-line therapy for conditions like Meniere's disease when more conservative treatments fail [1.3.4].
Effectiveness and Use: Steroid injections are valued because they are non-ablative, meaning they don't permanently damage the inner ear's balance function [1.3.5]. This makes them a preferable first choice over gentamicin, especially for patients who still have good hearing [1.8.1]. Studies have shown that intratympanic steroid injections can control vertigo in a significant number of cases. For instance, some research indicates that as-needed steroid injections can achieve complete vertigo control in up to 91% of cases at a two-year follow-up [1.3.5]. However, the effects can sometimes be short-lived, and patients may require repeated injections [1.3.5]. A 2023 Cochrane review noted that the overall evidence for the effectiveness of intratympanic corticosteroids is uncertain due to limitations in available studies [1.3.2].
Side Effects: Potential side effects are generally minimal and localized. They can include temporary pain, dizziness, a feeling of fullness in the ear, and, rarely, a persistent perforation (hole) in the eardrum [1.7.1, 1.7.2]. The risk of hearing loss is much lower compared to gentamicin [1.2.1].
Gentamicin Injections
Gentamicin is an antibiotic that is toxic to the cells of the inner ear (ototoxic) [1.6.4]. It works by intentionally damaging the vestibular (balance) cells in the problematic ear [1.2.1, 1.6.1]. The healthy ear then takes over the body's entire balance function [1.2.3]. This destructive, or ablative, approach is very effective at stopping vertigo attacks but is irreversible [1.6.3, 1.6.4].
Effectiveness and Use: Gentamicin is typically reserved for patients with severe, disabling vertigo who have not responded to other treatments and often already have significant hearing loss in the affected ear [1.6.1, 1.8.1]. It has a high success rate, with studies showing it controls vertigo in 80-90% of patients [1.6.3, 1.8.1]. The procedure involves one or more injections, often spaced a month apart, until symptoms of dizziness or imbalance appear, indicating the treatment is working [1.6.4].
Side Effects: The primary risk of gentamicin treatment is further hearing loss, which can occur in up to 30% of patients [1.6.4]. Because it destroys vestibular function in one ear, patients may experience a period of imbalance and unsteadiness after the procedure as their brain compensates [1.6.1, 1.6.3].
Comparison of Vertigo Injections
| Feature | Corticosteroid Injections (e.g., Dexamethasone) | Gentamicin Injections |
|---|---|---|
| Mechanism | Anti-inflammatory; reduces inner ear fluid pressure [1.3.5] | Destroys vestibular (balance) cells in the inner ear [1.6.1] |
| Effectiveness | Variable; may offer complete control in 50-90% of cases with 'as-needed' therapy [1.3.4, 1.3.5] | High; controls vertigo in 80-90% of patients [1.6.3, 1.8.1] |
| Primary Use | Second-line therapy for Meniere's, especially when hearing preservation is a goal [1.3.4, 1.8.1] | Severe, intractable vertigo, often when hearing is already poor [1.6.3, 1.8.1] |
| Permanence | Effects can be temporary; may require repeat injections [1.3.5] | Permanent, ablative effect on balance function [1.6.4] |
| Risk to Hearing | Low risk of hearing loss [1.2.1] | Significant risk of permanent hearing loss (approx. 15-30%) [1.6.1, 1.6.4] |
| Common Side Effects | Transient pain, dizziness, ear fullness, rare eardrum perforation [1.7.1, 1.7.2] | Imbalance during compensation period, risk of hearing loss [1.6.1, 1.6.3] |
Other Treatments for Vertigo
It's important to recognize that injections are not the only, or even the first, line of treatment for vertigo.
- Vestibular Rehabilitation Therapy (VRT): A specialized form of physical therapy that uses exercises to improve balance, gaze stability, and reduce dizziness [1.10.3].
- Canalith Repositioning Maneuvers: For BPPV, specific head movements like the Epley maneuver can be highly effective at moving displaced inner ear crystals that cause symptoms [1.10.1, 1.10.2].
- Oral Medications: Antihistamines (like Meclizine), benzodiazepines, and anti-emetics can be used to manage acute symptoms of vertigo and nausea [1.5.1, 1.5.3].
- Lifestyle and Dietary Changes: For Meniere's disease, a low-salt diet is often recommended to manage inner ear fluid levels [1.6.4]. Stress management and adequate hydration can also be beneficial [1.10.1, 1.10.2].
Conclusion
The injection for vertigo is not a single treatment but rather a targeted procedure, most often involving either corticosteroids or gentamicin. Corticosteroid injections offer a non-destructive option aimed at reducing inflammation with minimal risk to hearing, though their effects may be temporary [1.2.1, 1.3.5]. Gentamicin injections provide a more permanent, high-efficacy solution by disabling the balance function of the affected ear, but they carry a significant risk of hearing loss [1.6.1, 1.6.4]. The choice of injection depends on the underlying cause of the vertigo, its severity, the patient's hearing status, and a thorough discussion with a healthcare provider about the potential benefits and risks. These injections represent an important therapeutic option for patients with debilitating vertigo that has not responded to more conservative measures.
For more information on vestibular disorders, you can visit the Vestibular Disorders Association (VeDA).
