Do oral steroids help with Meniere's disease?

Oral Steroids for Ménière's Disease

Oral steroids have limited evidence for Ménière's disease and are not routinely recommended as first-line therapy, though they may provide modest benefit for vertigo control in select refractory cases. 1

Evidence Quality and Guideline Recommendations

The American Academy of Otolaryngology-Head and Neck Surgery guidelines explicitly note that oral steroids showed limited data with only one small pilot study demonstrating overall improvement in vertigo, while another study found no hearing improvement with oral steroids. 1 This represents weak evidence compared to other treatment modalities.

Key Findings from Available Evidence:

• One pilot study (n=16) showed oral prednisone (0.35 mg/kg daily for 18 weeks) reduced vertigo frequency by 50% and duration by 30%, with significant tinnitus reduction but no hearing improvement. 2

• No hearing benefit was demonstrated in available studies, which is a critical limitation since Ménière's disease affects both vestibular and auditory function. 1

• The evidence base is substantially weaker than for other interventions like intratympanic steroids or diuretics. 1, 3

Recommended Treatment Algorithm

First-line approach (prioritize these):

• Dietary sodium restriction (1500-2300 mg daily) 3
• Diuretics for maintenance therapy (moderate evidence quality) 1, 3
• Vestibular suppressants (antihistamines like meclizine, dimenhidrinato) only during acute attacks 3

Second-line for refractory disease:

• Intratympanic steroids are the preferred steroid delivery method when non-invasive treatments fail, showing 85-90% improvement in vertigo symptoms versus 57-80% with conventional therapy. 3, 4, 5
• Intratympanic dexamethasone provides better targeted delivery with fewer systemic side effects than oral administration. 4, 6

Oral steroids consideration:

• May be considered only for refractory vertigo after failure of first-line treatments 1, 2
• If used, prednisone 0.35 mg/kg daily has been studied, though evidence remains limited 2
• Bilateral Ménière's disease with suspected autoimmune etiology represents the most appropriate scenario for oral corticosteroids. 7

Critical Limitations and Cautions

Systemic side effects of oral steroids include:

• Hyperglycemia and weight gain (most common) 1
• Behavioral changes and increased appetite 1
• With prolonged use: adrenal suppression, avascular necrosis of femoral head, fatal varicella infection 1
• These risks are particularly concerning given the chronic, relapsing nature of Ménière's disease 1

Why intratympanic delivery is superior when steroids are indicated:

• Direct delivery to inner ear with minimal systemic absorption 4, 5
• Complete vertigo control (Class A) achieved in approximately 50% after single course, up to 91% with as-needed treatment 5
• Lower risk profile compared to systemic administration 4

What NOT to Use

The American Academy of Otolaryngology-Head and Neck Surgery explicitly recommends against:

• Positive pressure therapy (Meniett device) - no significant difference versus placebo 1, 3
• Prolonged or repetitive courses of oral steroids 1

Bottom line: If steroids are warranted for Ménière's disease, intratympanic administration is strongly preferred over oral delivery due to superior efficacy, better safety profile, and more robust evidence base. 3, 4, 5 Oral steroids should be reserved only for bilateral disease with suspected autoimmune mechanisms or when intratympanic delivery is not feasible. 7