Treatment for Ménière's Disease
The best treatment for Ménière's disease is a stepwise approach starting with dietary modifications (low-sodium diet of 1500-2300 mg daily) and lifestyle changes, followed by medications such as diuretics or antivertigo medications, and progressing to more invasive interventions only if symptoms remain uncontrolled. 1
First-Line Treatment: Diet and Lifestyle Modifications
Dietary restrictions:
- Low-sodium diet (1500-2300 mg daily)
- Limit alcohol consumption
- Limit caffeine intake
- Monitor for potential triggers including weather changes, allergies, and stress
Fluid management:
- Increase fluid intake to 2-3 liters per day to maintain adequate hydration 2
Second-Line Treatment: Medications
If dietary and lifestyle modifications are insufficient, consider adding:
- Diuretics - medications that remove excess body fluid to reduce endolymphatic pressure
- Antivertigo medications - for acute vertigo attacks
- Antihistamines - particularly if allergies may be contributing to symptoms
- Betahistine - a histamine analogue that increases vasodilation to the inner ear 1
Third-Line Treatment: Non-invasive Therapies
For patients who don't respond adequately to medications:
- Vestibular rehabilitation (physical therapy) - helps improve balance and reduce vertigo
- Hearing aids - for patients with significant hearing loss 1
Fourth-Line Treatment: Minimally Invasive Procedures
For refractory cases:
- Middle ear injections through the eardrum:
- Steroids - to reduce inflammation
- Gentamicin - chemical labyrinthectomy that reduces vestibular function 1
Fifth-Line Treatment: Surgical Options
Reserved for severe, refractory cases:
- Endolymphatic sac decompression (hearing sparing)
- Vestibular nerve section (hearing sparing)
- Labyrinthectomy (hearing ablative) - only considered when hearing is already severely compromised 1
Treatment Monitoring and Follow-up
- Keep a symptom journal to track attacks and identify potential triggers
- Regular follow-up with healthcare provider to assess treatment efficacy
- Adjust treatment based on symptom control and disease progression
Important Considerations
- There is no cure for Ménière's disease, but symptoms can be effectively managed
- Treatment should focus on controlling vertigo attacks, which are often the most debilitating symptom
- Hearing may worsen, stabilize, or fluctuate over time regardless of treatment
- The disease typically affects adults between 40-70 years of age
- Attacks and fluctuations in hearing, tinnitus, and ear fullness are sporadic and unpredictable
Common Pitfalls to Avoid
- Delaying treatment of acute vertigo attacks
- Failing to maintain consistent dietary sodium restriction
- Discontinuing treatments prematurely when symptoms improve
- Not addressing the psychological impact of the disease on quality of life
- Underestimating the importance of regular follow-up to adjust treatment as needed
Remember that Ménière's disease can significantly impact quality of life, causing patients to feel sick, tired, and anxious about future attacks. Regular communication with your healthcare provider is essential to manage symptoms effectively and improve overall well-being.