From the Guidelines
The recommended treatment for Meniere's disease typically follows a stepwise approach, beginning with lifestyle modifications and medications before considering more invasive options. Initial treatment includes reducing salt intake to 1500-2000mg daily, avoiding caffeine and alcohol, stopping smoking, and managing stress 1. Medications commonly prescribed include diuretics like hydrochlorothiazide (25-50mg daily) or acetazolamide to reduce fluid buildup in the inner ear, and anti-vertigo medications such as meclizine (25mg every 4-6 hours as needed) or diazepam (2-5mg) during acute attacks. For severe vertigo episodes, a short course of oral steroids like prednisone (starting at 60mg with taper over 10-14 days) may help.
Some key considerations in the treatment of Meniere's disease include:
- The use of vestibular rehabilitation/physical therapy for patients with chronic imbalance, as recommended by clinicians 1
- The potential benefits and risks of intratympanic steroid therapy, which may be offered to patients with active Meniere's disease not responsive to noninvasive treatment 1
- The recommendation against the use of positive pressure therapy, such as the Meniett device, due to a lack of compelling evidence for its effectiveness in treating vertigo in Meniere's disease 1
If these conservative measures fail after 3-6 months, more aggressive treatments can be considered, including intratympanic steroid or gentamicin injections directly into the middle ear. Gentamicin selectively damages vestibular cells to reduce vertigo but carries a risk of hearing loss. For refractory cases, surgical options include endolymphatic sac decompression, vestibular nerve section, or labyrinthectomy. These treatments aim to manage the triad of symptoms (vertigo, hearing loss, and tinnitus) by reducing endolymphatic fluid pressure in the inner ear, which is believed to be the underlying cause of Meniere's disease 1. Clinicians should document the resolution, improvement, or worsening of vertigo, tinnitus, and hearing loss, as well as any change in quality of life, in patients with Meniere's disease 1.
From the Research
Treatment Options for Meniere's Disease
The recommended treatment for Meniere's disease typically begins with conservative measures, including:
- Low salt diet
- Avoidance of stress and caffeine
- Sleep hygiene 2 Medical therapy with a diuretic is often the next step, and if symptoms persist, options such as intratympanic (IT) steroids and betahistine may be considered.
Medical Therapy
Studies have shown that various medications can be effective in managing Meniere's disease symptoms, including:
- Gentamicin, which has been found to be the most efficacious medication in some studies 3
- Methylprednisolone, which may be a good alternative to Gentamicin due to its lower risk of hearing loss 3
- Acetazolamide, which has been shown to be effective in reducing vertigo attacks, but is associated with a high rate of adverse events 4
Surgical Options
In some cases, surgical options may be considered, such as:
- Endolymphatic sac surgery, although its efficacy is controversial 2
- Vestibular nerve section or labyrinthectomy, which are typically reserved for patients with severe symptoms who do not respond to other treatments 2
Rehabilitative Options
Rehabilitative options, such as physical therapy and hearing aids, may also be recommended to help manage symptoms and improve quality of life 2