From the Guidelines
Treatment for Meniere's disease should prioritize a multidisciplinary approach, including lifestyle modifications, medications, and potentially surgical interventions, with the goal of reducing vertigo attacks, preserving hearing, and improving quality of life, as recommended by the most recent clinical practice guidelines 1.
Overview of Meniere's Disease
Meniere's disease is a clinical condition characterized by spontaneous vertigo attacks, low- to midfrequency sensorineural hearing loss, and fluctuating aural symptoms such as tinnitus and ear fullness in the affected ear. The underlying etiology involves inner ear fluid volume increases, leading to episodic symptoms.
Treatment Options
Treatment approaches for Meniere's disease are varied and include:
- Lifestyle modifications: Reducing salt intake to less than 2 grams daily, limiting alcohol and caffeine consumption, and stress management techniques can help alleviate symptoms 1.
- Medications:
- Diuretics like hydrochlorothiazide (25-50mg daily) or acetazolamide (250mg twice daily) to reduce fluid buildup in the inner ear.
- Betahistine (16mg three times daily) for long-term management to improve blood flow to the inner ear, though it's not FDA-approved in the US.
- Antivertigo medications such as diazepam (5-10mg) or lorazepam (1-2mg) for acute vertigo symptoms, and antiemetics like promethazine (25mg) or ondansetron (4-8mg) for nausea.
- Noninvasive therapies: Vestibular rehabilitation (physical therapy) and hearing aids can be beneficial.
- Surgical options: Reserved for severe cases, these include intratympanic steroid or gentamicin injections, endolymphatic sac decompression surgery, vestibular nerve section, or labyrinthectomy.
Patient Education and Support
Patient education is crucial, focusing on the natural history of the disease, symptom control measures, treatment options, and outcomes, as emphasized in recent guidelines 1. Support groups and educational resources, such as those provided by the Vestibular Disorders Association and the Meniere's Society, can offer valuable information and support for patients.
Quality of Life Considerations
The primary goal of treatment is to improve the patient's quality of life by reducing the frequency and severity of vertigo attacks and preserving hearing when possible. Treatment selection should be based on symptom frequency, severity, and impact on quality of life, with a focus on minimizing morbidity and mortality while maximizing quality of life outcomes 1.
From the Research
Treatment Options for Meniere's Disease
- Lifestyle changes: Modifications to daily habits, such as reducing stress and improving sleep patterns, can help alleviate symptoms of Meniere's disease 2.
- Dietary modifications: A low-sodium diet, reduction in daily alcohol and caffeine intake, and a gluten-free diet have been suggested as first-line treatments for Meniere's disease 2, 3, 4.
- Medical management: Intratympanic steroids, endolymphatic shunt surgery, and other nonablative therapies can be used to manage symptoms of Meniere's disease 5.
- Surgical methods: Endolymphatic sac surgery, including decompression, enhancement, and shunting, can be effective in controlling vertigo and preserving hearing in patients with Meniere's disease 6.
- Diuretics and vasodilator corticosteroids: These medications can help reduce fluid buildup in the inner ear and alleviate symptoms of Meniere's disease 2.
Specific Dietary Interventions
- Low-sodium diet: Restricting sodium intake to 1500mg/d has been shown to improve clinical efficacy in Meniere's disease patients 4.
- Adequate water intake: Drinking 35ml/kg/d of water can help improve hearing and alleviate vertigo and tinnitus in Meniere's disease patients 4.
- Reduction in caffeine and alcohol intake: Decreasing consumption of these substances can help reduce symptoms of Meniere's disease 2, 3.
Efficacy of Treatment Options
- The evidence for lifestyle and dietary interventions for Meniere's disease is very uncertain, with low or very low certainty of evidence for most outcomes 3.
- Endolymphatic sac surgery has been shown to be effective in controlling vertigo and preserving hearing in patients with Meniere's disease, with a high percentage of vertigo control and hearing preservation 6.
- Low-sodium diet with adequate water intake has been shown to improve clinical efficacy in Meniere's disease patients, with significant improvements in hearing, vertigo, and tinnitus 4.