Inner Ear, Meniere Disease, Medical Treatment Treatment & Management

Medical therapy is directed toward the mitigation of symptoms and/or their prevention.

In general, medications that decrease symptoms (eg, meclizine [Antivert], droperidol [Inapsine], prochlorperazine [Compazine], diazepam [Valium], lorazepam [Ativan], alprazolam [Xanax]) only mask the vertigo. These masking agents are vestibulosuppressants and work by dulling the brain's response to signals from the inner ear.

Some diuretics or medications with diuretic-like properties (eg, hydrochlorothiazide and triamterene [Dyazide], hydrochlorothiazide [Aquazide], acetazolamide [Diamox], methazolamide [Neptazane]) decrease fluid pressure in the inner ear. These medications help prevent attacks but do not help after the attack is triggered.

Steroids have also been helpful in treating endolymphatic hydrops because of their anti-inflammatory properties. Steroids can reverse vertigo, tinnitus, and hearing loss, probably by reducing endolymphatic pressure. Steroids can be given orally, intramuscularly, or even transtympanically. Although the transtympanic route is controversial, it is gaining wider acceptance throughout the otologic community.

Aminoglycosides are a class of antibiotics that were serendipitously discovered to be preferentially toxic to the vestibular (balance) end organ. Destruction of the vestibular end organ renders the brain insensitive to fluctuations in inner ear pressure brought on by Ménière disease. Given systemically, aminoglycosides affect both ears. Although aminoglycosides can be used to treat extremely severe bilateral Ménière disease, such treatment leaves the patient with little or no balance function. The resulting complete loss of inner ear function (ie, Dandy syndrome) can be debilitating.

One innovation in the treatment of Ménière disease is the Meniett device. Its use is not precisely a medical treatment, and the device itself does not require surgical installation. It does, however, require insertion of tympanostomy tube so that the device can work; therefore, its use may qualify as a surgical treatment. The Meniett device delivers pulses of pressure to the inner ear via the tympanostomy tube. Although no one knows exactly why this works, some patients have symptomatic relief when the device is used on a daily basis. Because it is new, long-term results have not been fully evaluated.

The histamine agonists that are used in countries outside of the United States must be mentioned. Medications such as betahistine (Serc) are widely used in Europe and South America. Although its mechanism of action is somewhat controversial, many have reported success with its use in mitigating symptoms of Ménière disease. Unfortunately, since betahistine (Serc) is not US Food and Drug Administration approved, it is not discussed much in the United States.

Surgical treatment is discussed in detail in the article Inner Ear, Ménière Disease, Surgical Treatment. Briefly, the 4 most generally accepted management options are endolymphatic sac decompression or shunt, vestibular nerve section, labyrinthectomy, and transtympanic medication perfusion.

One study by Pullens and Benthem showed that transtympanic gentamicin may be an effective treatment for vertigo complaints in Ménière's disease, but it carries a risk of increasing hearing loss. Further research is needed to clarify the effect of intratympanic gentamicin on vertigo in Ménière's disease and the risk of inducing or increasing hearing loss.^[2]

Because many differential diagnoses exist, consultations with the following specialists are recommended:

• Neurologist
• Cardiologist
• Endocrinologist
• Internal medicine specialist

• Patients who are not severely affected may choose to manage their disease through diet.
• Dietary management of endolymphatic hydrops is based on the avoidance of substances that may trigger or exacerbate fluid pressure buildup in the inner ear. As with systemic hypertension, the goal of managing Ménière disease is to reduce the total volume of body fluid. This reduction, in turn, may reduce the fluid volume in the inner ear.
• Avoidance of salt is one of the mainstays of therapy because sodium seems to play a major role in fluid retention in the inner ear.

  • Patients should avoid foods with high sodium content (eg, pizza, preserved foods, smoked fish).
  • Sodium nitrate is used in many preserved and smoked foods; therefore, these foods are high in sodium content.
  • A rigid salt-restricted diet is recommended (ie, 1.5 g sodium), under the guidance of a nutritionist.
• Avoidance of other trigger substances has also been shown to help. The following should be avoided: caffeine; nicotine; chocolate, which has shown to be a potent trigger substance; tobacco; alcohol, particularly red wine and beer; foods with high cholesterol or triglyceride content; foods with high carbohydrate content; and excessive sweets and candy.

Endolymphatic hydrops does not preclude regular activity. Exercise is recommended in moderation. Because of the unpredictable nature of the disease, balance-intensive dangerous tasks (eg, ladder use, precarious activities) should be avoided.