How are Meniere's disease symptoms managed?

From the Guidelines

Meniere's disease symptoms are managed through a combination of medications, lifestyle changes, and sometimes surgical interventions, with the primary goal of reducing the frequency and severity of vertigo attacks while managing associated hearing loss and tinnitus. The management of Meniere's disease involves a multifaceted approach, including:

• Medications: Diuretics like hydrochlorothiazide (25-50mg daily) or acetazolamide (250mg twice daily) to reduce fluid buildup in the inner ear, vestibular suppressants such as meclizine (25mg every 4-6 hours), diazepam (2-5mg as needed), or promethazine (25mg) for acute vertigo attacks, and anti-nausea medications like ondansetron (4-8mg) as needed 1.
• Lifestyle modifications: Reducing salt intake to less than 2g daily, limiting caffeine and alcohol consumption, stopping smoking, and managing stress through techniques like meditation or yoga are crucial in managing symptoms 1.
• Surgical interventions: For patients who do not respond to conservative management, intratympanic steroid or gentamicin injections, or surgical options such as endolymphatic sac decompression, vestibular nerve section, or labyrinthectomy may be considered 1.

It is essential to note that the management of Meniere's disease should be individualized, taking into account the patient's specific symptoms, medical history, and preferences. A comprehensive treatment plan should aim to improve the patient's quality of life by reducing the frequency and severity of vertigo attacks, managing associated symptoms, and minimizing the risk of complications 1.

From the Research

Meniere's Disease Symptoms Management

Meniere's disease is a condition that causes recurrent episodes of vertigo, associated with hearing loss and tinnitus. The management of these symptoms includes lifestyle modifications, medical treatment, and surgical interventions.

• Lifestyle modifications:
  • Changing lifestyle, such as reducing salt or caffeine intake 2
  • Vestibular rehabilitation in the intercritic period 3
  • Psychotherapy 3
• Medical treatment:
  • Diuretics and Betahistine as first-line treatment 3
  • Intratympanic injection of steroids as second-line treatment 3
  • Combination pharmacotherapy with betahistine and the MAO-B inhibitor selegiline 4
• Surgical interventions:
  • Endolymphatic sac surgery (when hearing is worth being preserved) 3
  • Intratympanic injection of gentamicin (with higher risks of hearing loss) 3
  • Labyrinthectomy, associated or not to cochlear implantation or vestibular nerve section (when hearing is worth being preserved) 3

Treatment Options and Rationale

The goal of treatment is to prevent attacks and delay disease progression. Non-ablative therapy options, such as intratympanic steroids and endolymphatic shunt surgery, are preferred prior to ablative techniques like intratympanic gentamicin 5. Recognition of concurrent migraine symptoms may aid in medical therapy and underscore the importance of preserving vestibular function where possible 5.

Efficacy of Interventions

The efficacy of different interventions is currently unclear, and the evidence for lifestyle or dietary interventions for Meniere's disease is very uncertain 2. Consensus on the appropriate outcomes to measure in studies of Meniere's disease is needed to guide future studies and enable meta-analyses of the results 2.