From the Guidelines
Treatment for Ménière's disease typically begins with lifestyle modifications and medications before considering more invasive options. Initially, reducing salt intake to 1500-2000mg daily helps decrease fluid retention in the inner ear 1. Diuretics like hydrochlorothiazide (25-50mg daily) or acetazolamide can help manage fluid balance. During acute vertigo attacks, vestibular suppressants such as meclizine (25mg every 4-6 hours), diazepam (2-5mg as needed), or promethazine can provide relief. Anti-nausea medications like ondansetron (4-8mg) may also help control symptoms. If these approaches are insufficient, intratympanic steroid injections (dexamethasone) or gentamicin therapy might be considered to reduce vertigo while potentially preserving hearing 1. For severe, refractory cases, surgical options include endolymphatic sac procedures, vestibular nerve section, or labyrinthectomy. The Meniett device, which delivers low-pressure pulses to the inner ear, represents another non-invasive option, although its effectiveness is still debated 1. Treatment should be individualized based on symptom severity, hearing status, and impact on quality of life, as Ménière's disease involves endolymphatic hydrops (excess fluid) in the inner ear, causing the characteristic triad of vertigo, fluctuating hearing loss, and tinnitus.
Some key considerations in managing Ménière's disease include:
- Reducing salt intake to minimize fluid retention in the inner ear
- Using diuretics to manage fluid balance
- Employing vestibular suppressants and anti-nausea medications to control vertigo and nausea
- Considering intratympanic steroid injections or gentamicin therapy for refractory cases
- Evaluating the potential benefits and risks of surgical options, such as endolymphatic sac procedures or labyrinthectomy
It is essential to prioritize individualized treatment based on the patient's specific symptoms, hearing status, and quality of life, as the goals of treatment are to prevent or reduce vertigo severity and frequency, relieve or prevent hearing loss, tinnitus, and aural fullness, and improve overall quality of life 1.
From the Research
Treatment Options for Ménière's Disease
- Lifestyle changes, such as dietary modifications, are recommended as a first-line treatment for Ménière's disease 2, 3
- Vestibular rehabilitation and psychotherapy may also be beneficial in managing the disease 2
- Conservative medical treatment options include diuretics and Betahistine, as well as local pressure therapy 2
- Intratympanic injection of steroids is recommended as a second-line treatment when medical treatment fails 2
- Other treatment options include endolymphatic sac surgery, intratympanic injection of gentamicin, and destructive surgical treatment such as labyrinthectomy 2
Medications for Ménière's Disease
- Betahistine is a commonly used medication for Ménière's disease, with its efficacy demonstrated in double-blind, randomized, placebo-controlled studies 4
- The combination of betahistine with the MAO-B inhibitor selegiline may be an effective alternative to high-dosage betahistine monotherapy 5
- Other medications that may be used for intratympanic injection include Gentamicin, Methylprednisolone, Latanoprost, Dexamethasone, and Ganciclovir 6
- Gentamicin was found to be the most efficacious medication in a network meta-analysis, followed by Methylprednisolone 6
Dietary Modifications
- A low sodium diet, reduction in daily alcohol and caffeine intake, and a gluten-free diet may be beneficial in preventing and treating Ménière's disease attacks 3
- Dietary modifications are considered a first-line treatment for Ménière's disease, and may be used in conjunction with other treatment options 3