Streptomycin drug fever during treatment of bilateral Meniere's disease.

The use of intramuscular injections of streptomycin sulfate for the ablation of vestibular function in patients with bilateral Meniere's disease is well established. Although hypersensitivity reactions to streptomycin are documented, frank drug fevers are rare. Our patient, with no previous history of drug allergies, was treated with parenteral streptomycin for disabling bilateral Meniere's disease. The patient's hospital course was complicated by severe hypotension and spiking fevers, which were temporally related to the streptomycin injections, and which resolved on cessation of the drug therapy. A challenge dose of a new batch of streptomycin resulted in renewed rigors, fever, and hypotension. The necessity of early recognition of this uncommon, life-threatening drug fever with streptomycin is emphasized by our experience.

Use of streptomycin sulfate in the treatment of Meniere's disease.

Streptomycin sulfate has been known to be ototoxic since its use in the treatment of tuberculosis. This report describes 10 years of experience in the treatment of Meniere's disease with streptomycin. Streptomycin has been used in classical Schuknecht ablation of the vestibular system in bilateral Meniere's disease; classical Schuknecht ablation of the vestibular system in unilateral Meniere's disease in the only hearing ear; intratympanic streptomycin in the treatment of unilateral Meniere's disease; and low-dose intramuscular streptomycin as outpatient treatment in unilateral Meniere's disease. The results of bilateral vestibular ablation were similar to Schuknecht's and others. Patients developed profound ataxia with a wide-based gait and oscillopsia, which improved rapidly over a period of months. Approximately 30% experienced significant improvement in hearing, which usually deteriorated again after several months. All patients were relieved of vertigo. Patients with unilateral Meniere's disease in the only hearing ear responded as did the bilateral cases. Hearing in the only hearing ear was preserved in all cases. Low-dose subototoxic streptomycin as outpatient treatment offers promise in some cases for relieving attacks of Meniere's disease while improving hearing without producing the temporary disabling effects of ataxia and oscillopsia. Streptomycin and similar drugs that may reduce the production of endolymph may eventually be the treatment of choice in Meniere's disease.