What are the treatment options for Ménière’s disease?

From the Guidelines

Treatment for Ménière's disease should prioritize a multidisciplinary approach, starting with lifestyle modifications and escalating to pharmacological and surgical interventions as needed, with the goal of minimizing morbidity, mortality, and improving quality of life. The treatment options for Ménière's disease can be categorized into several key areas:

• Lifestyle modifications:
  • Reducing salt intake to 1500-2300 mg daily 1
  • Limiting alcohol and caffeine consumption 1
  • Stress management techniques
• Medications:
  • Diuretics such as hydrochlorothiazide or acetazolamide to reduce inner ear fluid pressure 1
  • Vestibular suppressants like diazepam or lorazepam for acute vertigo management 1
  • Antihistamines for allergy treatment
  • Betahistine for its potential to increase vasodilation to the inner ear 1
• Noninvasive therapies:
  • Vestibular rehabilitation or physical therapy, particularly for patients who have failed less definitive therapy and have nonusable hearing 1
  • Hearing aids for managing hearing loss
  • Middle ear injections, including steroids or gentamicin, for symptom control 1
• Surgical options:
  • Endolymphatic sac decompression to reduce fluid pressure while preserving hearing 1
  • Vestibular nerve section to eliminate vertigo with potential hearing preservation 1
  • Labyrinthectomy as a last resort to eliminate vertigo but at the cost of hearing in the affected ear 1

It's crucial to individualize treatment based on symptom frequency, severity, and the impact on the patient's quality of life, considering the natural history of the disease and the potential benefits and harms of each intervention 1. Clinicians should educate patients about the disease's natural history, symptom control measures, treatment options, and expected outcomes, and document changes in symptoms and quality of life over time 1.

From the Research

Treatment Options for Ménière's Disease

• The treatment options for Ménière's disease include lifestyle changes, vestibular rehabilitation, psychotherapy, and medical treatments such as diuretics, Betahistine, and local pressure therapy 2.
• Intratympanic injection of steroids or gentamicin may be considered as a second or third line treatment, depending on the hearing function 2.
• A low-sodium diet with adequate water intake has been shown to improve clinical efficacy in Ménière's disease patients 3.
• Intratympanic gentamicin has been used to treat Ménière's disease, but the evidence for its effectiveness is very uncertain due to the limited number of studies and small sample sizes 4.

Medical Treatments

• Gentamicin was found to be the most efficacious medication for intratympanic injection, followed by Methylprednisolone, Latanoprost, Dexamethasone, and Ganciclovir in order of effectiveness 5.
• Methylprednisolone may be the best choice for the treatment of Ménière's disease by intratympanic injection, considering the potential risk of hearing loss induced by Gentamicin 5.

Lifestyle and Dietary Interventions

• Lifestyle or dietary modifications, such as reducing salt or caffeine intake, are sometimes suggested to be of benefit for Ménière's disease, but the evidence for their effectiveness is very uncertain 6.
• A low-sodium diet with adequate water intake has been shown to improve hearing and alleviate vertigo and tinnitus in Ménière's disease patients 3.