What are the treatment options for Meniere's (Meniere's disease)?

From the Guidelines

Meniere's disease treatment should prioritize symptom management, focusing on reducing vertigo severity and frequency, relieving hearing loss, tinnitus, and aural fullness, and improving quality of life, as recommended by the 2020 clinical practice guideline 1. The primary goals of treatment are to alleviate symptoms and improve patient outcomes.

Key Treatment Strategies

• Lifestyle modifications, including a low-salt diet, avoiding caffeine, alcohol, and tobacco, and stress management techniques, are essential for managing symptoms.
• Medications such as diazepam (Valium) 2-5 mg or meclizine (Antivert) 25-50 mg can be prescribed during acute attacks to manage vertigo, and promethazine (Phenergan) 12.5-25 mg for nausea, as suggested by the clinical practice guideline 1.
• For long-term management, diuretics like hydrochlorothiazide 25-50 mg daily or acetazolamide 250 mg twice daily can reduce inner ear fluid pressure, and betahistine (Serc) 16-24 mg three times daily may improve blood flow to the inner ear, although it's not FDA-approved in the US.
• A limited course of vestibular suppressants should be offered to patients with Ménière’s disease for management of vertigo only during Ménière’s disease attacks, as recommended by the clinical practice guideline 1.

Additional Considerations

• Regular follow-up with an otolaryngologist is crucial to monitor hearing and adjust treatment as needed.
• For severe cases unresponsive to medication, more invasive options, such as intratympanic steroid or gentamicin injections, endolymphatic sac decompression surgery, or vestibular nerve section, may be considered.
• Clinicians should document resolution, improvement, or worsening of vertigo, tinnitus, and hearing loss and any change in quality of life in patients with Ménière's disease, as emphasized by the clinical practice guideline 1.

From the Research

Treatment Options for Meniere's Disease

• Lifestyle changes, such as a low sodium diet, reduction in daily alcohol and caffeine intake, and a gluten-free diet, are considered first-line treatments for Meniere's disease 2
• Dietary modifications, including a reduction in salt and caffeine intake, may be beneficial in preventing vertigo attacks and associated symptoms 3, 4
• Medical therapy with a diuretic is often the next step in treatment, followed by options such as intratympanic steroids and betahistine if symptoms persist 5
• Other treatment options include the Meniett device, endolymphatic sac surgery, and ablative therapies like intratympanic gentamicin, although their efficacy is controversial 5

Medications Used in Treatment

• Betahistine is a commonly used medication in the treatment of Meniere's disease, with a mechanism of action that involves the central nervous system and neuronal systems involved in recovery from vestibular loss 6
• Betahistine has been shown to be effective in double-blind, randomized, placebo-controlled studies, although comparative studies with other drugs have yielded equivocal results 6
• Other medications, such as benzodiazepines and anti-emetics, may be used for symptomatic control during vertigo episodes 5

Alternative Therapies

• Vestibular rehabilitation and physical therapy may be beneficial for patients with unilateral vestibular weakness or hearing loss 5
• Alternative therapies, such as specially processed cereals, have been studied, but the evidence for their effectiveness is limited and of low certainty 3