What are the treatment options for Meniere's disease?

From the Guidelines

Treatment for Meniere's disease should prioritize a multidisciplinary approach, including lifestyle modifications, medications, and potentially invasive procedures, with the goal of reducing vertigo frequency and severity, alleviating associated symptoms, and improving quality of life, as recommended by the most recent clinical practice guidelines 1.

Initial Treatment Approaches

Initial management of Meniere's disease often involves lifestyle modifications, such as:

• Reducing salt intake to less than 2 grams daily
• Avoiding caffeine and alcohol
• Stress management techniques These changes are aimed at reducing the frequency and severity of vertigo attacks and alleviating other symptoms like tinnitus and aural fullness.

Medications

Medications play a crucial role in managing acute attacks and long-term symptoms:

• Vestibular suppressants like diazepam (5-10mg) or lorazepam (1-2mg) for vertigo
• Antiemetics such as promethazine (25mg) or ondansetron (4-8mg) for nausea
• Diuretics like hydrochlorothiazide (25-50mg daily) or acetazolamide (250mg twice daily) to reduce inner ear fluid pressure
• Betahistine (16mg three times daily), widely used internationally to reduce vertigo frequency, though not FDA-approved in the US

Invasive Options

For patients who do not respond to conservative treatments, more invasive options may be considered:

• Intratympanic steroid or gentamicin injections
• Endolymphatic sac decompression surgery
• Vestibular nerve section
• Labyrinthectomy for severe cases with no usable hearing

Vestibular Rehabilitation

Vestibular rehabilitation/physical therapy is recommended for patients with chronic imbalance or those who have undergone ablative therapy 1, as it can help promote gaze stability, habituate symptoms, improve balance and gait, and enhance overall quality of life.

Treatment Selection

Treatment selection should be individualized based on symptom frequency, severity, and impact on quality of life 1, considering the patient's specific needs and preferences. The goal is to minimize the adverse effects of therapies while maximizing symptom control and quality of life improvement.

From the FDA Drug Label

In patients with Meniere's disease, gentamicin is used to treat the symptoms of the disease. The treatment options for Meniere's disease include intratympanic gentamicin injection.

• The goal of treatment is to reduce the frequency and severity of vertigo episodes.
• Gentamicin is an antibiotic that is used to treat Meniere's disease by reducing the amount of fluid in the inner ear.
• The intratympanic injection of gentamicin is a procedure where the drug is injected directly into the middle ear.
• This treatment option is usually considered for patients who have not responded to other treatments or who have severe symptoms. 2

From the Research

Treatment Options for Meniere's Disease

The treatment options for Meniere's disease can be categorized into medical and surgical approaches.

• Medical treatment includes the use of betahistine and acetazolamide to control vertigo, as shown in a study published in 2000 3.
• Surgical options are considered when medical treatment fails to control vertigo, and include procedures such as endolymphatic sac shunt, labyrinthectomy, and vestibular nerve section, as discussed in a 2010 review article 4.

Surgical Treatment Options

Surgical treatment options for Meniere's disease aim to control vertigo and improve balance function.

• Endolymphatic sac shunt is a surgical procedure that involves creating a shunt to drain excess endolymph from the inner ear, as discussed in a 2010 review article 4.
• Labyrinthectomy is a surgical procedure that involves removing the labyrinth, which can provide excellent control of intractable vertigo, as shown in a 1997 study 5.
• Vestibular nerve section is a surgical procedure that involves cutting the vestibular nerve to prevent vertigo, as discussed in a 2000 study 3.

Emerging Treatment Options

There are emerging treatment options for Meniere's disease, including:

• Intratympanic steroid and gentamicin injections, which can be used as in-office therapies for medically refractory Meniere's disease, as discussed in a 2023 review article 6.
• Triple Semicircular Canal Occlusion (TSCO), a partially ablative procedure that holds promise for controlling vertigo in Meniere's disease, as mentioned in a 2023 review article 6.
• Cochlear implants, which can be used to rehabilitate hearing loss associated with Meniere's disease, as discussed in a 2023 review article 6.

Role of Vestibular Rehabilitation

Vestibular rehabilitation can play a role in the treatment of Meniere's disease, particularly in patients who experience disequilibrium or unsteadiness between attacks, as shown in a 2005 study 7.

• Vestibular physical therapy can help improve balance function and reduce symptoms of vertigo and disequilibrium, as demonstrated in a 2005 study 7.