Chemical perfusion of the inner ear is an increasingly popular treatment for Ménière’s disease. The authors report on the long-term results of 22 patients treated with gentamicin delivered via a round window micro-catheter. Patients with Ménière’s disease underwent continuous, low dose (10 mg/ml) gentamicin infusion at 5 microlitre per hour for 10 days, through a micro-catheter placed into the round window niche. Vertigo was controlled in 95 per cent, whilst preserving hearing in 77 per cent. Hearing improved in three patients. Three patients with pre-operative serviceable hearing (PTA < 50 db) demonstrated reduced hearing; two patients with pre-operative non-serviceable hearing developed a dead ear. Tinnitus and aural fullness remained unchanged or improved in 86 per cent and 68 per cent respectively. Long-term vertigo control can be achieved using low dose gentamicin, whilst preserving hearing and vestibular function in the majority of patients. This procedure appears to stabilize the vestibular function, enhancing the chance of effective vestibular rehabilitation.