From the Guidelines
Treatment options for Meniere's disease include both conservative approaches and more invasive interventions depending on symptom severity, with the primary goal of preventing or reducing vertigo severity and frequency, relieving or preventing hearing loss, tinnitus, and aural fullness, and improving quality of life, as stated in the clinical practice guideline: Ménière's disease executive summary 1. The treatment approaches for Meniere's disease are varied and typically include modifications of lifestyle factors, medical, surgical, or a combination of therapies. Initial treatment typically involves lifestyle modifications such as:
- Reducing salt intake to 1500-2000mg daily
- Avoiding caffeine and alcohol
- Stopping smoking
- Managing stress Medications are often prescribed to control specific symptoms, including:
- Diuretics like hydrochlorothiazide (25-50mg daily) or acetazolamide to reduce inner ear fluid
- Anti-vertigo medications such as meclizine (25mg every 4-6 hours as needed), diazepam (2-5mg), or promethazine to manage acute vertigo attacks
- Anti-nausea drugs like ondansetron (4-8mg) to control associated nausea For patients who don't respond to these treatments, middle ear injections of gentamicin may be used to reduce vertigo by partially destroying balance function, or steroid injections (dexamethasone) may help reduce inflammation with fewer side effects, as recommended in the clinical practice guideline: Ménière's disease 1. Surgical options for severe, refractory cases include:
- Endolymphatic sac procedures to reduce fluid pressure
- Vestibular nerve section to eliminate vertigo while preserving hearing
- Labyrinthectomy which eliminates vertigo but sacrifices remaining hearing in the affected ear These treatments aim to address the underlying excess fluid in the inner ear (endolymphatic hydrops) that causes the characteristic symptoms of vertigo, fluctuating hearing loss, tinnitus, and aural fullness, as explained in the clinical practice guideline: Ménière's disease executive summary 1. It is essential to educate patients with Ménière's disease about the natural history, measures for symptom control, treatment options, and outcomes, as stated in the clinical practice guideline: Ménière's disease 1. The goals of treatment are to prevent or reduce the severity and frequency of vertigo attacks, relieve or prevent hearing loss, tinnitus, and aural fullness, and improve overall quality of life, as stated in the clinical practice guideline: Ménière's disease executive summary 1. Clinicians should document resolution, improvement, or worsening of vertigo, tinnitus, and hearing loss and any change in quality of life in patients with Ménière's disease, as recommended in the clinical practice guideline: Ménière's disease executive summary 1. Vestibular rehabilitation/physical therapy may be offered to patients with Ménière's disease who have failed less definitive therapy and have nonusable hearing, as recommended in the clinical practice guideline: Ménière's disease executive summary 1. Diuretics and/or betahistine may be offered for maintenance therapy to reduce symptoms or prevent attacks, as recommended in the clinical practice guideline: Ménière's disease executive summary 1. Clinicians should counsel patients, or refer to a clinician who can counsel patients, with Ménière's disease about the natural history, measures for symptom control, treatment options, and outcomes, as stated in the clinical practice guideline: Ménière's disease executive summary 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, 3.
- Dietary modifications:
- Low sodium diet: Restricting salt intake is a commonly recommended treatment for Meniere's disease, as it can help reduce fluid retention in the inner ear 2, 4, 5.
- Reduction in daily alcohol and caffeine intake: Limiting or avoiding these substances may also help manage symptoms 2, 5.
- Gluten-free diet: Some studies suggest that a gluten-free diet may be beneficial for patients with Meniere's disease, although more research is needed to confirm this 2.
- Medical treatments:
- Diuretics: These medications can help reduce fluid buildup in the inner ear and alleviate symptoms 2.
- Vasodilator corticosteroids: These medications can help improve blood flow to the inner ear and reduce inflammation 2.
- Intratympanic steroids: Injecting steroids directly into the middle ear can help reduce inflammation and alleviate symptoms 2.
- Surgical methods: In some cases, surgery may be necessary to relieve symptoms of Meniere's disease, such as vertigo and hearing loss 2.
- Vestibular rehabilitation: This type of physical therapy can help improve balance and reduce symptoms of vertigo and dizziness 6.
Efficacy of Treatment Options
- The evidence for lifestyle and dietary interventions for Meniere's disease is very uncertain, and more research is needed to determine their effectiveness 3.
- There is no evidence from randomized controlled trials to support or refute the restriction of salt, caffeine, or alcohol intake in patients with Meniere's disease or syndrome 5.
- High-quality research is warranted to determine the best treatment options for Meniere's disease and to assess the potential harms or unwanted effects of dietary modification 5.