Treatments: Meniere’s Disease

While Meniere’s disease does not have a cure, the aims of treatment are:

• to reduce the number, severity and duration of vertigo attacks;

• to prevent progression of the disease, in particular the loss of hearing; and

• to alleviate any chronic symptoms (e.g. tinnitus and a sense of ear fullness).

These may be accomplished with noninvasive therapy.

The main medical approaches to prevent Meniere’s attacks consist of: 1) Getting good sleep, including treatment of obstructive sleep apnea, if present, 2) minimizing stress, 3) minimizing alcohol, caffeine, and tobacco, 4) consuming a low salt diet possibly with possible use of a diuretic medication (sometimes called a “water pill”), 6) psychologic therapy, including cognitive behavioral therapy, 7) use of betahistine medication, and 8) use of lipoflavinoid medication.

Lessening the severity an active attack is often accomplished with a medication to treat nausea (such as meclizine) and a medication to treat the anxiety that accompanies dizziness (such as lorazepam). Use of steroids, taken as a pill or by injection into the ear in an office procedure may also help with an acute attack or flare ups in a series of attacks.

Managing residual deficits from prior attack(s) may include vestibular physical therapy for any residual imbalance after an attack.

Invasive and destructive treatments may be considered as a last resort select circumstances, such as disabling attacks not responsive to more conservative treatments. These involve intentionally damaging the vestibular system of the inner ear with the intention of preventing future attacks, understanding that the damage is permanent and the individual would need to manage with only the one inner ear balance system on the untreated ear. Permanent disabling of the affected inner ear may be accomplished with injection of a medicine (an aminoglycoside, like gentamycin) through a tiny hole in the eardrum. In addition to destruction of the inner ear balance (vestibular) system, this treatment may also cause permanent hearing loss on the treated side. Surgical treatments for Meniere’s disease are typically reserved for severe cases in which medical therapy has proven ineffective. The least destructive of the typical operative options involves decompressing the endolymphatic sac (with or without placement of a valve). For the most severe cases, cutting the balance nerve (vestibular neurectomy) or surgically removing the inner ear (labyrinthectomy) may be considered. Hearing in that ear may be permanently lost with vestibular neurectomy and is always lost with labyrinthectomy.

Eventually, after about 5-15 years of symptoms, Meniere’s disease usually “burns out” whereby hearing and balance function from the affected ear is lost, episodes of the world spinning generally stop and the person is left with mild loss of balance, moderately poor hearing in the affected ear, and ringing in their ear. The balance system may compensate based on the other ear, though this is aided by balance therapy and maintained by ongoing challenge to the vestibular system.