Treatment and management of Ménière’s disease

So far, there is no cure for Ménière’s disease and the hearing loss associated with it. But there are several treatments that may help make the vertigo symptoms less severe.

The treatment or treatments that your healthcare team suggests may depend on:

• your age
• how frequent and severe your symptoms are
• whether you also have other conditions such as migraine, arthritis or allergies
• the health of your other ear

Your ear specialist may want to try lifestyle changes and medication first, especially if your symptoms are mild. If these do not work, other more invasive options may be suggested such as ear injections or surgery.

It is important to remember that Ménière’s disease fluctuates. Sometimes it gets better for a while on its own. This means that it can be hard to tell if a particular treatment is working, or if the symptoms just happened to start getting better at the same time as you started taking the treatment. It also means that it is harder to study treatments for Ménière’s disease. Some studies may show that a treatment has a good effect, or no effect, just by chance.

Researchers do know that some treatments for Ménière’s disease definitely do not work any better than a placebo. A placebo is a comparison treatment that is used during research studies. It looks the same as the treatment that is being studied, but it does not have any effect.

Diet

Diet changes are often recommended for people with Ménière’s disease. There is very little scientific evidence that these changes make a difference. But some people do find them helpful, and they are unlikely to do any harm, so you and your ear specialist may decide to try them. Keeping a health diary may help you determine whether or not dietary changes make a difference. The most common changes are:

• eating a diet that is low in sodium (salt)
• getting less than 100 mg of caffeine per day
• avoiding foods that often trigger migraines and may trigger Ménière’s attacks, including monosodium glutamate (MSG), chocolate, red wine, dairy products, and aged or pickled foods

Medication

Medications for Ménière’s disease include:

• Betahistine (Serc®), which is often prescribed for Ménière’s disease. Some studies have found that it works to control vertigo attacks, but other studies have found that it does not work any better than a placebo. Betahistine is used in Europe and Canada, but not in the United States. It has few side effects for most people, and seems to work for some people, so your doctor may suggest trying it to see if it works for you.
• Diuretics, also known as “water pills,” are often prescribed to reduce the fluid build-up in the inner ear. They do not work for all patients, and may have side effects.

Some research suggests that diuretics may help to slow the progression of hearing loss when combined with a low-sodium diet.

• Medications to reduce the frequency and severity of vertigo or nausea during attacks, such as antihistamines, dimenhydrinate (Gravol®) or sometimes diazepam (Valium®).

Be sure to tell your doctor about all the medications you are taking, including vitamins, minerals, and herbal, homeopathic or over-the-counter medications. These can sometimes cause side effects or make other medications less effective.

Ear injections

If medication and lifestyle changes are not enough, more invasive treatments may be needed. Some treatments involve injecting medication into the middle ear through the eardrum (transtympanic injections). In most cases, these treatments are done over several sessions.

• Steroid injections may be helpful in some cases. The goal of this treatment is to reduce inflammation. There is evidence that steroid injections reduce the frequency and severity of spells. With steroids, there is little risk of hearing loss.
• Gentamicin is an antibiotic that damages the cells of the ear and destroys the part of the ear that controls balance. In most cases, patients who have this treatment no longer have vertigo. But there is a risk of hearing loss with this treatment. People may also have balance problems after the treatment; if this happens, vestibular rehabilitation may be helpful.

Surgery

If other treatments do not work, and vertigo is severely affecting your quality of life, one of the following types of surgery may be recommended:

• Endolymphatic (EN-doe-lim-FAT-ick) decompression, where the surgeon removes bone from around the sac that drains fluid from the inner ear. Vertigo symptoms get better in about two-thirds of patients who have this surgery, although about the same number of patients improve without surgery. One advantage of this surgery is that it does not affect hearing. There is a small risk of spinal fluid leak with this procedure.
• Vestibular neurectomy, where the surgeon cuts the nerve that goes from the balance portion of the inner ear to the brain. For most patients, Ménière’s attacks go away completely after this procedure. But it is major surgery with a risk of side effects, including spinal fluid leak, infection or stroke.
• Labyrinthectomy, where the surgeon removes the entire inner ear. This surgery is usually very successful at stopping symptoms, but it also causes total loss of hearing in the affected ear. It is usually done only in older patients or patients who already have profound hearing loss.

Most patients will have some symptoms after vestibular neurectomy or labyrinthectomy, including dizziness, blurred vision and unsteadiness. Usually, they will need vestibular rehabilitation. Be aware that any destructive form of treatment comes with a risk: in about 40% of cases, Ménière’s becomes bilateral (both ears affected) after surgery. You may end up with bilateral vestibulopathy and have more serious impairments.

Vestibular rehabilitation and balance retraining

Vestibular rehabilitation is a type of exercise-based therapy. Its goal is to help your body and brain relearn how to balance. Some people find that it helps them be more confident when doing their everyday activities. But it will not prevent future attacks. Vestibular rehabilitation is not usually recommended in the early episodic stage of Ménière’s because the brain cannot adjust to the fluctuating nature of the disorder. In later stages, if balance symptoms remain, vestibular rehabilitation may be helpful.