From the Guidelines
Meniere's disease is a chronic inner ear disorder that should be managed with a combination of lifestyle modifications and medical therapies to reduce vertigo severity and frequency, relieve hearing loss, tinnitus, and aural fullness, and improve quality of life, as recommended by the clinical practice guideline: Ménière's disease 1.
Key Components of Management
- Lifestyle modifications: reducing salt intake to less than 2 grams per day, avoiding caffeine, alcohol, and tobacco, and managing stress
- Medications for acute attacks: antihistamines like meclizine (25-50mg every 4-6 hours as needed), anti-nausea medications such as ondansetron (4-8mg), and diazepam (2-5mg) for severe vertigo
- Long-term management: diuretics like hydrochlorothiazide (25-50mg daily) or acetazolamide (250mg twice daily) to reduce fluid pressure in the inner ear
- Betahistine (16-24mg three times daily) to reduce vertigo frequency, although not FDA-approved in the US
Invasive Options
- Intratympanic steroid or gentamicin injections
- Endolymphatic sac decompression surgery
- Labyrinthectomy in severe cases
Monitoring and Follow-up
- Regular follow-up with an otolaryngologist to monitor symptoms and adjust treatment as needed
- Documentation of resolution, improvement, or worsening of vertigo, tinnitus, and hearing loss, and any change in quality of life after treatment, as recommended by the clinical practice guideline 1
From the Research
Definition and Symptoms of Meniere's Disease
- Meniere's disease (MD) is a disorder of the inner ear that causes vertigo attacks, fluctuating hearing loss, tinnitus, and aural fullness 2.
- The disease is characterized by episodic vestibular symptoms associated with sensorineural hearing loss, tinnitus, and aural pressure 3.
- Symptoms of MD include vertigo, hearing loss, tinnitus, and aural fullness, as well as headache during attacks, and bilateral involvement is found in 25-40% of cases 3.
Diagnosis of Meniere's Disease
- The diagnosis of MD is based on clinical symptoms, but can be complemented with functional inner ear tests, including audiometry, vestibular-evoked myogenic potential testing, caloric testing, electrocochleography, or head impulse tests 2.
- MRI has been optimized to directly visualize endolymphatic hydrops (EH) in the cochlea, vestibule, and semicircular canals, and its use is shifting from the research setting to the clinic 2.
- Clinical criteria for diagnosis include an episodic vertigo syndrome associated with low- to medium-frequency sensorineural hearing loss and fluctuating aural symptoms (hearing loss, tinnitus, and/or fullness) in the affected ear 3.
Treatment and Management of Meniere's Disease
- The management of MD is mainly aimed at the relief of acute attacks of vertigo and the prevention of recurrent attacks 2.
- Therapeutic options are based on empirical evidence and include the management of risk factors and a conservative approach as the first line of treatment 2.
- Treatment options include sodium restriction, betahistine, intratympanic gentamicin, or steroids, and eventually surgery, such as cochlear implantation 3.
- Vestibular rehabilitation (Tetrax biofeedback) has been shown to improve the quality of life and reduce the risk of falling in patients with MD 4.
- The combination of betahistine and the MAO-B inhibitor selegiline has been found to be effective in reducing the frequency of acute attacks of vertigo in patients with MD, with a significantly lower dosage of betahistine needed to achieve the same treatment response 5.
Vestibular Rehabilitation and Fall Risk
- Vestibular rehabilitation treatment (VRT) has been proven to be an effective method for controlling vestibular symptoms and has been applied to patients with various vestibular diseases 6.
- A randomized controlled trial is currently being conducted to investigate the efficacy of VRT versus usual care in MD patients who experience persistent unsteadiness after intratympanic gentamicin treatment 6.
- The study aims to understand whether VRT has a positive impact on balance maintenance and vertigo control in patients with MD, with outcomes assessments including the Functional Gait Assessment, sensory organisation test, and vestibular laboratory tests 6.