eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Inner Ear

Inner Ear, Meniere Disease, Medical Treatment: Follow-up

Author: John C Li, MD, Private Practice in Otology and Neurotology; Medical Director, Balance Center
Contributor Information and Disclosures

Updated: Mar 25, 2009

Follow-up

Further Inpatient Care

  • Further inpatient treatment is directed toward controlling nausea, vomiting, and dehydration in patients with acute vertigo.
  • Intravenous or intramuscular diazepam can be used in addition to antinausea medication, which may provide excellent vestibular suppression and antinausea effects.
  • Steroids can be used for their anti-inflammatory effects in the inner ear.
  • Intravenous fluid support can help prevent dehydration and replace electrolytes.

Further Outpatient Care

Vestibular Rehabilitation: Because of its fluctuating nature, vestibular therapy is not particularly useful as a primary treatment of Ménière disease. However, it is useful in the rehabilitation of patients who have undergone vestibular ablation. In fact, vestibular rehabilitation is strongly recommended in those who have undergone aminoglycoside perfusion, labyrinthectomy, and vestibular nerve section.

Complications

  • Accidents due to vertigo spells
  • Disability due to unpredictable vertigo
  • Progressive imbalance and deafness
  • Intractable tinnitus
  • Benign positional vertigo: More evident suggests that patients who have Ménière's disease manifest with benign positional vertigo.

Prognosis

  • The prognosis of patients with Ménière disease varies.
    • The pattern of exacerbation and remission makes the evaluation of treatment and prognosis difficult. In general, the patient's condition tends to spontaneously stabilize over time. Ménière disease is said to "burn out" over time.
    • Studies show that about one half of all cases of vertigo spontaneously stabilize after several years.
    • However, this stabilization comes at a price. Patients are left with poor balance and poor hearing.
  • Some authors classify Ménière disease into several stages of progression.
    • Early stages involve cochlear hydrops, which then proceed to affect the vestibular apparatus. Ménière syndrome is most bothersome to patients during these early stages.
    • Episodes of vertigo disappear in later stages when room for pressure fluctuation is eliminated by complete vestibule filling. Acute attacks are replaced with constant imbalance problems and progressive hearing loss.
  • In order to introduce uniformity in the diagnosis and treatment of Ménière disease, the AmericanAcademy of Otolaryngology first issued guidelines in 1972. These guidelines were revised in 1985 and again updated in 1995.2 The guidelines require analysis of symptoms, audiometric results, and functional impairment to allow staging. This staging tool is now widely used diagnostically and also as a measure of treatment outcome.

Patient Education

For excellent patient education resources, visit eMedicine's Brain and Nervous System Center and Ear, Nose, and Throat Center. Also, see eMedicine's patient education articles Ménière Disease and Tinnitus.

 


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Multimedia: Inner Ear, Meniere Disease, Medical Treatment
References
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References

  1. Paparella MM. Benign paroxysmal positional vertigo and other vestibular symptoms in Ménière disease. Ear Nose Throat J. Oct 2008;87(10):562. [Medline].

  2. Monsell EM. New and revised reporting guidelines from the Committee on Hearing and Equilibrium. American Academy of Otolaryngology-Head and Neck Surgery Foundation, Inc. Otolaryngol Head Neck Surg. Sep 1995;113(3):176-8. [Medline].

  3. Bretlau P, Thomsen J, Tos M, et al. Placebo effect in surgery for Menière's disease: nine-year follow-up. Am J Otol. Jul 1989;10(4):259-61. [Medline].

  4. Densert B, Sass K. Control of symptoms in patients with Meniere's disease using middle ear pressure applications: two years follow-up. Acta Otolaryngol. Jul 2001;121(5):616-21. [Medline].

  5. Glasscock ME 3rd, Jackson CG, Poe DS, et al. What I think of sac surgery in 1989. Am J Otol. May 1989;10(3):230-3. [Medline].

  6. Gottshall KR, Hoffer ME, Moore RJ, et al. The role of vestibular rehabilitation in the treatment of Meniere's disease. Otolaryngol Head Neck Surg. Sep 2005;133(3):326-8. [Medline].

  7. Kato BM, LaRouere MJ, Bojrab DI, et al. Evaluating quality of life after endolymphatic sac surgery: The Ménière's Disease Outcomes Questionnaire. Otol Neurotol. May 2004;25(3):339-44. [Medline].

  8. Kitahara T, Kondoh K, Morihana T, et al. Surgical management of special cases of intractable Meniere's disease: unilateral cases with intact canals and bilateral cases. Ann Otol Rhinol Laryngol. May 2004;113(5):399-403. [Medline].

  9. Monsell EM, Wiet RJ. Endolymphatic sac surgery: methods of study and results. Am J Otol. Sep 1988;9(5):396-402. [Medline].

  10. Odkvist LM, Arlinger S, Billermark E, et al. Effects of middle ear pressure changes on clinical symptoms in patients with Ménière's disease--a clinical multicentre placebo-controlled study. Acta Otolaryngol Suppl. 2000;543:99-101. [Medline].

  11. Pyykkö I, Ishizaki H, Kaasinen S, et al. Intratympanic gentamicin in bilateral Menière's disease. Otolaryngol Head Neck Surg. Feb 1994;110(2):162-7. [Medline].

  12. Shea JJ Jr. Classification of Menière's disease. Am J Otol. May 1993;14(3):224-9. [Medline].

  13. Shea JJ Jr, Ge X. Streptomycin perfusion of the labyrinth through the round window plus intravenous streptomycin. Otolaryngol Clin North Am. Apr 1994;27(2):317-24. [Medline].

  14. Silverstein H, Lewis WB, Jackson LE, et al. Changing trends in the surgical treatment of Ménière's disease: results of a 10-year survey. Ear Nose Throat J. Mar 2003;82(3):185-7, 191-4. [Medline].

  15. Silverstein H, Smouha E, Jones R. Natural history vs. surgery for Menière's disease. Otolaryngol Head Neck Surg. Jan 1989;100(1):6-16. [Medline].

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Further Reading

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Keywords

meniere's disease, menieres disease, meniere disease, meniere, inner ear, meniere disease medical treatment, endolymphatic hydrops, cochleovestibular hydrops, cochlear hydrops, vestibular hydrops, Meniere syndrome, Ménière syndrome, Meniere disease, Ménière disease, Meniere's syndrome, Ménière's disease

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Contributor Information and Disclosures

Author

John C Li, MD, Private Practice in Otology and Neurotology; Medical Director, Balance Center
John C Li, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Neurotology Society, American Tinnitus Association, Florida Medical Association, and North American Skull Base Society
Disclosure: Nothing to disclose.

Medical Editor

Michael E Hoffer, MD, Director, Spatial Orientation Center, Department of Otolaryngology, Naval Medical Center of San Diego
Michael E Hoffer, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery
Disclosure: American biloogical group Royalty Other

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Gerard J Gianoli, MD, Clinical Associate Professor, Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine; Vice President, The Ear and Balance Institute; Chief Executive Officer, Ponchartrain Surgery Center
Gerard J Gianoli, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Neurotology Society, American Otological Society, Society of University Otolaryngologists-Head and Neck Surgeons, and Triological Society
Disclosure: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown

 
 
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