From the Guidelines
Meniere's disease treatment should prioritize lifestyle modifications, including a low-sodium diet, limiting alcohol and caffeine intake, and managing stress, as these changes can help decrease symptoms and improve quality of life. According to the clinical practice guideline: Ménière's disease executive summary 1, the goals of treatment are to prevent or reduce vertigo severity and frequency, relieve or prevent hearing loss, tinnitus, and aural fullness, and improve quality of life.
Some key points to consider in managing Meniere's disease include:
- Reducing salt intake to less than 2 grams daily, as recommended in the clinical practice guideline: Ménière's disease 1
- Avoiding caffeine, alcohol, and tobacco
- Managing stress through techniques such as meditation or yoga
- Medications for acute attacks, including antihistamines like meclizine (25mg every 4-6 hours as needed), anti-nausea medications such as promethazine (12.5-25mg every 4-6 hours), and benzodiazepines like diazepam (2-5mg as needed) for severe vertigo
- For long-term management, diuretics like hydrochlorothiazide (25-50mg daily) or acetazolamide (250mg twice daily) may help reduce fluid pressure in the inner ear, as suggested in the clinical practice guideline: Ménière's disease executive summary 1
It's essential to note that while there is no cure for Meniere's disease, proper management can significantly reduce the frequency and severity of attacks, allowing most patients to maintain a good quality of life 1. Patients should be encouraged to join a support group to gain knowledge, resources, and support from others, such as the Vestibular Disorders Association or the Meniere's Society 1.
From the Research
Diagnosis of Meniere's Disease
- Diagnosis is made with a characteristic patient history, including discrete episodes of vertigo lasting 20 min or longer, accompanied by sensorineural hearing loss, aural fullness, and tinnitus 2
- Workup includes audiometry, a contrast-enhanced MRI of the internal auditory canals, and exclusion of other diseases that can produce similar symptoms 2
Treatment Options
- Conservative measures, including low salt diet, avoidance of stress and caffeine, and sleep hygiene 2, 3
- Medical therapy with a diuretic is the usual next step 2, 3
- Intratympanic (IT) steroids and betahistine are discussed if diuretic therapy fails to control symptoms 2, 4
- Next tier treatments include the Meniett device and endolymphatic sac surgery, but the efficacy of both is controversial 2, 5
- Ablative therapies like intratympanic gentamicin are considered if the above measures fail to provide symptomatic control of vertigo 2, 5
Efficacy of Interventions
- Evidence on the efficacy of interventions for patients with Meniere's disease is generally of low certainty 5
- Betahistine and positive pressure therapy probably do not reduce Meniere's disease symptoms when compared with placebo 5, 6
- Intratympanic injection with gentamicin or steroids, or treatment with endolymphatic surgery may reduce symptoms in Meniere's disease when compared with placebo 5