From the Guidelines
Meniere's disease treatment should focus on managing symptoms and preventing vertigo attacks, with a multidisciplinary approach including lifestyle modifications, medications, and possibly surgery, as recommended by the 2020 clinical practice guideline 1. The treatment of Meniere's disease can be categorized into several areas, including:
- Lifestyle modifications:
- Low-sodium diet (1500-2300 mg daily)
- Limiting alcohol consumption
- Limiting caffeine intake
- Medications:
- Diuretics to remove excess body fluid
- Antivertigo medications for acute vertigo symptoms
- Antihistamines to treat allergies
- Betahistine (histamine analogue to increase vasodilation to inner ear)
- Noninvasive therapies:
- Vestibular rehabilitation (physical therapy)
- Hearing aids
- Middle ear injections through the ear drum in the affected ear
- Steroids
- Gentamicin
- Surgery:
- Endolymphatic sac decompression (hearing sparing)
- Vestibular nerve section (hearing sparing)
- Labyrinthectomy (hearing ablative) It is essential to note that there is no cure for Meniere's disease, but these treatments can help manage the condition and control symptoms, as stated in the 2020 clinical practice guideline 1. In terms of specific treatment options, intratympanic steroid injections with dexamethasone or gentamicin may be considered for persistent symptoms, as recommended by the 2020 clinical practice guideline 1. Additionally, patient education is crucial in managing Meniere's disease, and clinicians should educate patients about the natural history, measures for symptom control, treatment options, and outcomes, as recommended by the 2020 clinical practice guideline 1. Overall, the goal of treatment is to improve the patient's quality of life by reducing the frequency and severity of vertigo attacks and managing other symptoms, as stated in the 2020 clinical practice guideline 1.
From the Research
Treatment Options for Meniere's Disease
- Conservative measures are often the first line of treatment, including a low salt diet, avoidance of stress and caffeine, and sleep hygiene 2
- Medical therapy with a diuretic is the usual next step if conservative measures fail to control symptoms 2, 3, 4
- Other treatment options include:
- Intratympanic (IT) steroids and betahistine 2
- The Meniett device and endolymphatic sac surgery, although their efficacy is controversial 2
- Ablative therapies like intratympanic gentamicin for severe symptoms that do not respond to other treatments 2
- Vestibular nerve section or labyrinthectomy in rare cases where other treatments have failed 2
- Rehabilitative options for unilateral vestibular weakness include physical therapy, and for unilateral hearing loss include conventional hearing aids, contralateral routing of sound (CROS), and osseointegrated hearing aids 2
Dietary Modifications
- A low sodium diet is often recommended as a first-line treatment for Meniere's disease 5, 3
- Reduction in daily alcohol and caffeine intake may also be beneficial 5
- A gluten-free diet and a new dietary approach to specially processed grains may also be considered 5
Pharmacological Interventions
- Betahistine, diuretics, antivirals, and corticosteroids have been used in the management of Meniere's disease, although their efficacy is unclear 6
- A systematic review of diuretics in the medical management of Meniere's disease found that oral diuretic therapy may be beneficial in improving vertigo episode frequency, with less convincing evidence for improvement in hearing outcomes 4