Vestibular disorders: intratympanic gentamicin in Meniere disease: practice question

A ENT question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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ENT · Vestibular disorders: intratympanic gentamicin in Meniere disease

Sample item

A 52-year-old with unilateral Meniere disease has disabling vertigo despite salt restriction, a diuretic and betahistine, and still has serviceable hearing. Intratympanic gentamicin is offered. How does it control the vertigo?

AIt blocks histamine receptors in the vestibular nucleiBIt dissolves displaced otoconia in the semicircular canalsCIt lowers endolymph secretion by the stria vascularisDIt damages vestibular hair cells, reducing abnormal input from that ear

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. It damages vestibular hair cells, reducing abnormal input from that ear

Gentamicin is preferentially vestibulotoxic. Placed in the middle ear it diffuses through the round window and causes a partial chemical ablation of vestibular hair cells, so vertigo attacks fall in frequency. The price is a risk of further hearing loss, so it is used in low doses and only when conservative therapy has failed.

Option by option

A. It blocks histamine receptors in the vestibular nuclei
Histamine receptor blockade is the action of drugs such as cinnarizine or dimenhydrinate given systemically.
B. It dissolves displaced otoconia in the semicircular canals
Dissolving otoconia is not a mechanism of gentamicin and is relevant to BPPV, not Meniere disease.
C. It lowers endolymph secretion by the stria vascularis
Reduced endolymph production is the aim of diuretics and salt restriction, not of intratympanic gentamicin.
D. It damages vestibular hair cells, reducing abnormal input from that ear (correct)
Correct. Gentamicin selectively damages vestibular hair cells, producing a chemical labyrinthectomy that reduces vertigo with some risk to hearing.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this ENT question

What is the answer to this ENT question?

The best answer is D, It damages vestibular hair cells, reducing abnormal input from that ear. Gentamicin is preferentially vestibulotoxic.

Why is "It blocks histamine receptors in the vestibular nuclei" not the answer?

Histamine receptor blockade is the action of drugs such as cinnarizine or dimenhydrinate given systemically.

Why is "It dissolves displaced otoconia in the semicircular canals" not the answer?

Dissolving otoconia is not a mechanism of gentamicin and is relevant to BPPV, not Meniere disease.

Why is "It lowers endolymph secretion by the stria vascularis" not the answer?

Reduced endolymph production is the aim of diuretics and salt restriction, not of intratympanic gentamicin.

What concept does this question test?

It tests Vestibular disorders: intratympanic gentamicin in Meniere disease in ENT. Placed in the middle ear it diffuses through the round window and causes a partial chemical ablation of vestibular hair cells, so vertigo attacks fall in frequency. The price is a risk of further hearing loss, so it is used in low doses and only when conservative therapy has failed.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Vestibular disorders: intratympanic gentamicin in Meniere disease?

Learn tuning fork results and audiogram patterns by sketching them. Then use the flashcards and the other ENT questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.