There are some patients and physicians who voice concern regarding the long-term consequences of developing Meniere’s in the second ear if the first ear has had intratympanic gentamicin (ITG) treatment. There are at least 3 reasons why this concern is not relevant to treatment(i) regardless of whether the fifirst ear receives ITG, the balance organs of that ear will continue to degenerate so activation of disease in the second ear will lead to bilateral vestibular hypofunction whether or not the fifirst ear is treated; (ii) there is no evidence to suggest that ITG treatment has any effect on the fate of the second ear—it neither increases nor decreases risk of future bilateral Meniere’s disease; and (iii) it is the present vertigo attacks that are disabling and must be treated—one can neither predict possible future involvement of the second nor predict what future treatments may be available at that time. Thus, the patient is best served by offering treatment for control of the problem at hand.

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