The toxicity of certain aminoglycoside antibiotics for vestibular hair cells has been used to special advantage in the treatment of Meniere's disease. Intratympanic (middle ear) injections of these drugs are being increasingly used to control vertigo in this disorder when it has not responded to medical therapy. The mechanisms by which these drugs enter and affect the hair cells and the subsequent effects on the vestibular nerves and reflexes will be reviewed. The risk of hearing loss from these treatments compares favorably to the risk of hearing loss from the natural history of the disease or from other surgical treatments. The use of intratympanic gentamicin in Meniere's disease and other disorders will be discussed. Finally, potential therapies to prevent ototoxic damage will also be reviewed.