From the Guidelines
Meniere's disease treatment should focus on managing symptoms like vertigo, hearing loss, and tinnitus, with first-line treatments including lifestyle modifications and medications to reduce fluid buildup in the inner ear, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 1.
Key Treatment Strategies
- Lifestyle modifications: reducing salt intake (limiting to 1,500-2,000 mg daily), avoiding caffeine, alcohol, and tobacco, and managing stress
- Medications: diuretics like hydrochlorothiazide (25-50 mg daily) or acetazolamide to reduce fluid buildup in the inner ear
- Vestibular suppressants: meclizine (25 mg every 4-6 hours), diazepam (2-5 mg as needed), or promethazine for acute vertigo attacks
- Anti-nausea medications: ondansetron (4-8 mg) for relief during acute vertigo attacks
Additional Treatment Options
- Intratympanic steroid or gentamicin injections for patients who don't respond to first-line treatments
- Endolymphatic sac procedures or vestibular nerve section in severe cases
- The Meniett device, which applies low-pressure pulses to the ear canal, may benefit some patients
Importance of Follow-up
Regular follow-up with an otolaryngologist is essential to monitor hearing and adjust treatment as the disease progresses, as emphasized in the clinical practice guideline by the American Academy of Otolaryngology-Head and Neck Surgery 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Treatment Options for Meniere's Disease
- Conservative measures, including low salt diet, avoidance of stress and caffeine, and sleep hygiene, are often the first line of treatment 2
- Medical therapy with a diuretic is the usual next step if conservative measures fail to control symptoms 2
- Intratympanic (IT) steroids and betahistine are discussed as options if medical therapy is not effective 2
- The efficacy of the Meniett device and endolymphatic sac surgery is controversial 2
- Ablative therapies like intratympanic gentamicin are considered if other measures fail to provide symptomatic control of vertigo 2
- Vestibular nerve section or labyrinthectomy is rarely considered for patients with severe symptoms who do not show a reduction in vestibular function with gentamicin 2
Medications Used in Treatment
- Betahistine is used worldwide to treat patients with Meniere's disease, but its effectiveness is still a topic of debate 3, 4, 5
- Betahistine may reduce the number of attacks, vertigo intensity, and lead to symptomatic improvement, but the certainty of evidence is low 5
- Betahistine probably does not have significant adverse effects 5
- Diuretics, such as thiazide diuretics, are also used in combination with betahistine to prevent attacks and delay disease progression 6
Non-Pharmacological Interventions
- Dietary interventions, such as salt restriction and caffeine restriction, may help prevent attacks and delay disease progression 6
- Vestibular rehabilitation and psychological support may also be beneficial for patients with Meniere's disease 6
- Physical therapy and rehabilitative options, such as conventional hearing aids and osseointegrated hearing aids, can help with unilateral vestibular weakness and hearing loss 2