medical treatment
Last reviewed 07/2022
Initially majority of patients will respond to lifestyle interventions and a trial of betahistines for three months
Managing an acute attack (1)
- the patient should lay down on a firm surface during the acute attack
- should stay as motionless as possible, with the eyes open and fixed on a stationary object
- drinking or sipping water should be avoided (this may cause vomiting)
- the patient should be kept like this until the severe vertigo is passed
- may get up very slowly, once the vertigo disappears.
- during an acute attack of Meniere's disease, the patient is likely to vomit
- oral medication used to suppress the symptoms of acute vestibular attacks (vestibular sedatives) include
- cinnarizine, 15-30 mg t.d.s. or
- phenothiazines such as prochlorperazine 5-10mg tds - regular long term basis is not recommended, or
- promethazine, cyclizine, or,
- metoclopramide, or,
- benzodiazepine – can be used with caution for short periods
Measures for prevention of acute attacks
- lifestyle interventions (dietary control) - the goal is to provide stable body fluid/blood levels to avoid secondary fluctuations in the inner ear fluid
- food and fluid intake should be even throughout the day
- foods or fluids that have a high salt content should be avoided
- there should be adequate intake of fluids daily
- may contain water, milk and low-sugar fruit juices
- caffeine-containing fluids and foods (coffee, tea and chocolate) should be avoided.
- alcohol intake should be limited to one glass of beer or wine each day
- foods containing MSG (monosodium glutamate)also should be avoided
- reducing or stopping smoking
- medical management
- betahistine
- a starting dose of 16 mg three times a day will result in a reduction of the frequency and severity of attacks
- however there is limited evidence for a strong effect of betahistine
in preventing attacks
- diuretics
- although there is lack of evidence to support their use, diuretics may
sometimes be offered to patients based on the biological model of endolymphatic
hydrops
- corticosteroids
- both oral steroids and intratympanic steroid injections have been used
in the treatment of acute and chronic symptoms
- medical ablation
- used in patients with intractable vertigo
- intratympanic use of aminoglycosides (gentamicinin) to relieve vertigo and preservation of hearing s(1,2,3)
Other treatment options used in Meniere's disease include:
- vestibular rehabilitation
- physical therapy used to improve vestibular function and mechanisms of central adaptation and compensation
- may include Cawthorne-Cooksey exercises and low-impact exercise, such as cycling or walking
- useful in patients with stable, non-fluctuating vestibular loss
- adjunctive therapy - psychological or psychiatric intervention, e.g.- cognitive behavioural therapy, and techniques such as relaxation and breathing exercises
- pressure pulse treatment
- is a non invasive methodised for intractable vertigo in patients with Meniere’s disease
- positive pressure provided through a pulse-generator into the ear canal (1,2,3)
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