From the Guidelines
Diuretics are indicated for Meniere's disease as a maintenance therapy to reduce symptoms or prevent attacks, as stated in the 2020 clinical practice guideline by the American Academy of Otolaryngology-Head and Neck Surgery 1. The use of diuretics, such as thiazide diuretics like hydrochlorothiazide (25-50 mg daily) or potassium-sparing diuretics like acetazolamide (250 mg twice daily), is supported by observational studies and a Cochrane review, which show a balance of benefits and harms, with a preponderance of benefit over harms 1. Key points to consider when prescribing diuretics for Meniere's disease include:
- Starting with a lower dose and increasing as needed
- Regular monitoring of electrolytes, particularly potassium levels
- Maintaining adequate hydration while avoiding excessive fluid intake
- Reducing sodium intake to less than 2 grams daily
- Being aware of potential initial side effects, such as increased urination, dizziness, and electrolyte imbalances, which typically resolve with continued use. The goal of diuretic therapy in Meniere's disease is to reduce endolymphatic hydrops, the excess fluid buildup in the inner ear that causes the characteristic symptoms of the disease, including vertigo, fluctuating hearing loss, tinnitus, and aural fullness 1.
From the Research
Diuretics in Meniere's Disease
- The use of diuretics in Meniere's disease has been studied in various trials, with some showing improvement in vertigo episode frequency, but less convincing evidence for improvement in hearing outcomes 2.
- A systematic review found that oral diuretic therapy may be beneficial in the medical management of Meniere's disease, with 79% of studies reporting improvement in vertigo outcomes and 42.1% reporting improvement in hearing outcomes 2.
- However, another review found insufficient good evidence of the effect of diuretics on vertigo, hearing loss, tinnitus, or aural fullness in clearly defined Meniere's disease 3.
Efficacy and Safety of Diuretics
- A study found that diuretics may have an adverse effect on inner ear function due to an abrupt lowering of blood pressure, potentially causing local ischemia and damage 4.
- Another study found that Dyazide (a diuretic) had no significant effect on hearing or tinnitus, but decreased vestibular complaints significantly 5.
- The efficacy of diuretics in Meniere's disease is still uncertain, with some studies suggesting potential benefits and others raising concerns about potential harm 6, 4.
Clinical Use of Diuretics
- Diuretics are commonly used in the treatment of Meniere's disease, despite the lack of clear evidence for their effectiveness 2, 4.
- Some studies suggest that diuretics may be useful in reducing vertigo episode frequency, but their effect on hearing outcomes is less clear 2, 5.
- Clinicians should carefully consider the potential benefits and risks of diuretic therapy in Meniere's disease, and monitor patients closely for any adverse effects 6, 4.