What is the treatment for Meniere's disease?

Treatment for Meniere's Disease

The first-line treatment for Meniere's disease includes vestibular suppressants such as meclizine for acute vertigo attacks, along with lifestyle modifications including a low-sodium diet (1500-2300 mg daily), limiting alcohol and caffeine intake, and stress management. 1

Initial Management Approach

Acute Attack Management

• First-line therapy for acute vertigo attacks:
  • Vestibular suppressants (meclizine) 1
  • Antiemetics for nausea (ondansetron) 1
  • Benzodiazepines may be used but carry dependency risks 1

Lifestyle Modifications

• Dietary changes:
  • Low-sodium diet (1500-2300 mg daily) 2, 1
  • Limit alcohol consumption 2, 1
  • Limit caffeine intake 2, 3
  • Consider keeping a food diary to identify personal triggers 2
• Other lifestyle adjustments:
  • Stress management techniques 2, 1
  • Adequate sleep in darkness 1

Medication Management

Second-Line Therapies

• Diuretics:

  • Thiazides (e.g., hydrochlorothiazide) 2, 1
  • Potassium-sparing diuretics 1
  • Loop diuretics 1
  • These help reduce endolymph volume, though high-quality evidence for efficacy is limited 1

• Other medications:

  • Betahistine (16-48 mg daily) - use with caution in patients with asthma or peptic ulcer disease 1
  • Antihistamines (for allergies that may trigger symptoms) 2

Advanced Interventions for Refractory Cases

Intratympanic Treatments

• Middle ear injections through the eardrum:
  • Steroids for persistent symptoms 2, 1
  • Gentamicin for vertigo control in refractory cases (note: may affect hearing) 2, 1

Surgical Options (when medical management fails)

• Hearing-sparing procedures:
  • Endolymphatic sac decompression 2, 1
  • Vestibular nerve section 2
• Hearing-ablative procedures:
  • Labyrinthectomy (for severe cases with profound hearing loss) 2

Supportive Therapies

• Vestibular rehabilitation (physical therapy) for chronic imbalance between attacks 2, 1
• Hearing aids for patients with hearing loss 2, 1

Monitoring and Follow-up

• Document baseline severity of vertigo, tinnitus, and hearing loss 1
• Obtain regular audiograms to monitor hearing function 1
• Assess impact on quality of life 1
• Schedule regular follow-ups to evaluate symptom improvement or worsening 1

Important Considerations

Disease Education

• Meniere's disease is a chronic condition with no cure, only symptom management 1
• Symptoms may fluctuate unpredictably over time 2
• About 10-25% of patients develop bilateral disease over time, impacting treatment decisions 1

Treatment Pitfalls to Avoid

• Delaying treatment while awaiting additional testing (Meniere's is primarily a clinical diagnosis) 1
• Using the Meniett device (positive pressure therapy), as systematic reviews show no significant benefit over placebo 1
• Prolonged use of vestibular suppressants outside of acute attacks (may delay central compensation) 1
• Failing to rule out vestibular migraine, which can coexist with or mimic Meniere's disease 1

Evidence Limitations

• Despite widespread recommendations for dietary modifications, high-quality evidence from randomized controlled trials is limited 4
• No international consensus exists on the management of different stages of Meniere's disease 5

Support groups can provide valuable resources and emotional support for patients coping with this chronic condition 2.