Even though there has been iatrogenic injury to the peripheral vestibular apparatus due to ototoxicity, this can be put to use in the therapy of Meniere's disease. Meniere's disease, a condition of unknown etiology, has the clinical spectrum of sudden attacks of severe vertigo, progressive hearing loss, roaring in the ears or tinnitus, and a sensation of fullness in the ears. While medical therapy can be beneficial to some people in the form of vestibular suppressant medication and diuretics, eventually 10% or more of persons suffering from Meniere's disease become so disabled that surgery is considered. Destructive procedures such as labyrinthectomy have been proposed for the control of Meniere's disease. However, aminoglycosides may be used to treat Meniere's disease18-21 because of the differential effect on vestibular hair cells as opposed to cochlear hair cells. Therefore, selective end organ lesion may be achieved with a relative preservation of hearing. Initially, intramuscular streptomycin was employed.18,22,23 More recently, aminoglycosides have been applied to the middle ear in unilateral Meniere's disease. Schuknecht24 initially developed a technique to administer streptomycin solution to the middle ear via catheter tubing. More recently, different protocols have been employed with gentamicin to reduce the incidence of hearing loss.25-27 Now a standard technique is to inject gentamicin through the tympanic membrane. In one series of twenty patients, with at least two years follow up, vertigo was controlled in 90%.27 Injections into the lateral semicircular canal have also been employed, however these cause hearing loss in a high proportion of patients.28 It is believed now that intratympanic administration seems to be the most promising for future development and treatment.29,30 The effects can be titrated by giving smaller doses over a period of time which, hopefully, will result in effective therapy for Meniere's disease with preservation of hearing.