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, and more invasive options for refractory cases. 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.
Initial Treatment
Initial treatment typically includes:
- Lifestyle modifications such as reducing salt intake to less than 2 grams daily, limiting caffeine and alcohol, stopping smoking, and managing stress
- Medications prescribed during acute attacks, including:
- Diuretics like hydrochlorothiazide (25-50 mg daily) or acetazolamide to reduce fluid buildup
- Antihistamines such as meclizine (25 mg every 4-6 hours) for dizziness
- Anti-nausea medications like ondansetron (4-8 mg as needed) for vertigo-related nausea
- For persistent symptoms, 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
More invasive options for refractory cases include:
- Intratympanic steroid or gentamicin injections
- Endolymphatic sac procedures
- Vestibular nerve section These treatments aim to reduce endolymphatic hydrops (fluid buildup in the inner ear), which is believed to cause the symptoms by creating pressure that disrupts normal balance and hearing function 1
Comprehensive Approach
A comprehensive approach combining multiple strategies often provides the best symptom control. This may include a combination of lifestyle modifications, medications, and more invasive options, as well as patient education and support 1.
It is essential to note that the treatment of Meniere's disease should be individualized, and the most effective approach may vary from patient to patient. Therefore, a thorough evaluation and discussion with a healthcare provider are necessary to determine the best course of treatment for each patient.
From the Research
Treatment Options for Meniere's Disease
- Medical management is the primary approach for treating Meniere's disease, with the goal of controlling vertigo and other symptoms 2, 3, 4.
- Lifestyle and dietary interventions, such as reducing salt and caffeine intake, may also be beneficial, although the evidence is uncertain 5, 6.
- Surgical options, including endolymphatic-mastoid shunt, middle fossa vestibular nerve section, and labyrinthectomy, may be considered for patients who do not respond to medical management 2.
Medical Management
- Medications such as diuretics and vestibular suppressants may be used to control vertigo and other symptoms 3, 6.
- Transtympanic therapies, including intratympanic steroids and gentamicin, may also be effective in managing Meniere's disease 3, 4.
- Psychological counseling and stress management may be beneficial in reducing the frequency and severity of vertigo episodes 2.
Surgical Interventions
- Endolymphatic-mastoid shunt is a surgical procedure that involves creating a shunt to drain excess fluid from the inner ear 2.
- Middle fossa vestibular nerve section is a surgical procedure that involves cutting the vestibular nerve to reduce vertigo symptoms 2.
- Labyrinthectomy is a surgical procedure that involves removing the inner ear to eliminate vertigo symptoms, although it may result in hearing loss 2.
Lifestyle and Dietary Interventions
- Reducing salt intake may help decrease the frequency and severity of vertigo episodes 5, 6.
- Increasing fluid intake and getting adequate sleep may also be beneficial in managing Meniere's disease 5.
- Avoiding triggers such as caffeine and stress may help reduce the frequency and severity of vertigo episodes 5.