From the Guidelines
Meniere's disease treatment should focus on managing symptoms like vertigo, hearing loss, tinnitus, and ear fullness, with initial treatment typically including lifestyle modifications and medications to reduce fluid buildup and alleviate symptoms. The goals of treatment are to prevent or reduce vertigo severity and frequency, relieve or prevent hearing loss, tinnitus, and aural fullness, and improve quality of life 1.
Treatment Options
- Lifestyle modifications: reducing salt intake to less than 2 grams daily, limiting caffeine and alcohol, stopping smoking, and managing stress 1
- Medications: diuretics like hydrochlorothiazide (25-50 mg daily) or acetazolamide to reduce fluid buildup, antihistamines such as meclizine (25-50 mg every 4-6 hours) for dizziness, and anti-nausea medications like ondansetron (4-8 mg as needed) or promethazine (12.5-25 mg every 4-6 hours) 1
- Betahistine (16 mg three times daily) may help improve blood flow in the inner ear, though it's not FDA-approved in the US 1
- More invasive options for severe cases: intratympanic steroid or gentamicin injections, endolymphatic sac procedures, or vestibular nerve section 1
Patient Education
- Clinicians should educate patients with Meniere's disease about the natural history, measures for symptom control, treatment options, and outcomes 1
- Patient education can improve symptom control, quality of life, and treatment outcomes 1
Follow-up and Monitoring
- Regular follow-up with an otolaryngologist is essential to monitor disease progression and adjust treatment as needed 1
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 is the primary approach for most patients, with the goal of managing symptoms and preventing attacks 2.
- The treatment of the acute phase of Meniere's disease is basically symptomatic, with vestibular suppressant drugs used to control acute attacks of vertigo 2.
- Long-term management of Meniere's disease includes a low-salt diet, the use of diuretics in the post-crisis phase, and the use of histaminergic agents 2.
- Corticosteroids are used in bilateral forms of Meniere's disease, particularly if an autoimmune basis is suspected 2.
- Intratympanic injection of gentamicin can be beneficial when vertigo persists despite optimal medical management 3.
Surgical Options
Surgical indications are rare and the least invasive procedures are used first 2.
- Endolymphatic sac shunt, labyrinthectomy, and vestibular nerve section are surgical options for vertigo control in Meniere's disease 4.
- Labyrinthectomy and translabyrinthine vestibular nerve section both offer excellent control of intractable vertigo, but patients undergoing translabyrinthine vestibular nerve section are more likely to show improvement in imbalance and functional disability 4.
Lifestyle and Dietary Modifications
Lifestyle changes and dietary modifications are also important in the management of Meniere's disease.
- A low-sodium diet, reduction in daily alcohol and caffeine intake, and a gluten-free diet are recommended 5.
- Dietary modification is a first-line treatment for Meniere's disease, with the goal of preventing attacks and treating symptoms 5.
- Diuretics, such as isosorbide, hydrochlorothiazide, and acetazolamide, may be beneficial in the medical management of Meniere's disease, with improvement in vertigo episode frequency consistently reported 6.