I. Kaufman Arenberg, MD, Christine Lemke, DVM

IntraEAR, Inc. (formerly Neuro-Biometrix, Inc.), Greenwood Village, Colorado, USA

The optimal treatment plan for Meniere’s disease addresses both acute and short-term symptomatic relief of vertigo as well as the preservation or improvement of long-term auditory and vestibular system function. Medical treatment of Meniere’s disease should be directed at preventing its clinical manifestations, or “curing” the problem by treating it at its source, without resorting to destructive therapy. Efforts toward this goal have already begun. Numerous physicians in the United States and abroad are delivering various medications to the round window area of the middle ear, to treat inner ear disease. Applications that suggest future promise for the treatment of Meniere’s disease include: aminoglycosides, steroids, local anesthetics, calcium channel antagonists, cochlear blood flow agents, osmotic or hyper-osmotic diuretics, and C-type natriuretic peptide (CNP).

The Round Window m Cath (RWm Cathä ) and Round Window Electrode Cath (RWE-Cathä ) are dual-lumen micro-catheters specifically designed to allow accurate, direct drug delivery, targeting the round window membrane. The RWE-Cathä includes a built-in platinum electrode at the delivery tip, for electrocochleography (ECoG). The potential advantages of delivering agents directly to the inner ear, via the RWm Cathä or RWE-Cathä , include: enhanced treatment specificity, maintenance of precise inner ear drug concentrations, and limited systemic side effects. Additional possible benefits include: sustained, controlled, micro-dose delivery pre-, during and/or post-therapeutic intervention, and combination or sequential administration of other therapies. With the RWE-Cathä , ECoG can be measured before, during or after the delivery of medicine, to monitor changes in cochlear potentials – adverse or beneficial. The RWE-Cathä is designed to provide useful objective electrophysiological feedback to enhance the treating physician’s ability to titrate and more accurately micro-dose the drug therapy.

While there will always be a place for invasive surgeries, ever-improving drug delivery devices and techniques will probably lead to direct drug delivery, with micro-dosing, becoming the treatment of choice for Ménière’s disease.