From the Guidelines
Meniere's disease treatment should focus on managing symptoms and preventing vertigo attacks, starting with lifestyle modifications and medical therapies, with the goal of controlling vertigo while preserving hearing and minimizing medication side effects. The treatment approach should be individualized based on symptom severity, and regular follow-up with an otolaryngologist is essential to monitor disease progression and treatment effectiveness 1.
Lifestyle Modifications
Lifestyle modifications are crucial in managing Meniere's disease symptoms. These include:
- Reducing salt intake to less than 2 grams daily
- Limiting caffeine and alcohol
- Stopping smoking
- Managing stress These modifications can help alleviate symptoms and improve quality of life 1.
Medical Therapies
For acute vertigo attacks, medications like diazepam (2-10mg), meclizine (25-50mg), or promethazine (25mg) can provide relief 1. Daily preventive medications include betahistine (16-24mg three times daily), which may improve blood flow to the inner ear, or a diuretic like hydrochlorothiazide (25-50mg daily) to reduce fluid pressure 1.
Invasive Options
For severe cases unresponsive to medical therapy, more invasive options include:
- Intratympanic gentamicin injections to reduce vestibular function
- Endolymphatic sac procedures to reduce fluid pressure
- Vestibular nerve section as a last resort These options should be considered only after careful evaluation and discussion with an otolaryngologist 1.
Quality of Life
The goals of Meniere's disease 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 1. Treatment approaches should aim to enhance patient preferences and preference-centered care to minimize the adverse effects of therapies in both scope and frequency.
From the Research
Treatment Options for Meniere's Disease
The treatment options for Meniere's disease can be categorized into several approaches, including:
- Lifestyle changes and dietary modifications, such as a low-sodium diet, reduction in daily alcohol and caffeine intake, and a gluten-free diet 2
- Pharmacological treatment using diuretics, betahistine, and other drugs to manage symptoms such as vertigo, tinnitus, and hearing loss 3, 4
- Local pulsated pressure treatment in the ear canal, which has shown significant improvement in vertigo, tinnitus, and hearing in some patients 3
- Gentamicin treatment, which has been used in more severe cases to cure vertigo, although it may cause hearing loss in some cases 3, 5
- Surgical methods, which are rarely used and typically reserved for cases where other treatments have failed 4, 5
- Intratympanic injection of gentamicin or steroids, which can be used to manage vertigo and other symptoms 4, 5
Medical Management
Medical management of Meniere's disease typically involves a combination of the following:
- Vestibular suppressant drugs to control acute attacks of vertigo 4
- Diuretics to reduce fluid retention and alleviate symptoms 3, 4, 6
- Histaminergic agents, which are commonly used in Europe to manage symptoms 4
- Corticosteroids, which may be used in bilateral forms of Meniere's disease or when an autoimmune basis is suspected 4
Dietary Modifications
Dietary modifications play a crucial role in the management of Meniere's disease, including: