Treatment of Menière’s Disease

Opinion statement

Diagnosis of Menière’s disease is made with a characteristic patient history, including discrete episodes of vertigo lasting 20 min or longer, accompanied by sensorineural hearing loss, which is typically low frequency at first, aural fullness, and tinnitus. Workup includes audiometry, a contrast enhanced MRI of the internal auditory canals, and exclusion of other diseases that can produce similar symptoms, like otosyphilis, autoimmune inner ear disease, perilymphatic fistula, superior semicircular canal syndrome, Lyme disease, multiple sclerosis, vestibular paroxysmia, and temporal bone tumors. A history of migraine should be sought as well because of a high rate of co-occurrence (Rauch, Otolaryngol Clin North Am 43:1011–1017, 2010). Treatment begins with conservative measures, including low salt diet, avoidance of stress and caffeine, and sleep hygiene. Medical therapy with a diuretic is the usual next step. If that fails to control symptoms, then the options of intratympanic (IT) steroids and betahistine are discussed. Next tier treatments include the Meniett device and endolymphatic sac surgery, but the efficacy of both is controversial. If the above measures fail to provide symptomatic control of vertigo, then ablative therapies like intratympanic gentamicin are considered. Rarely, vestibular nerve section or labyrinthectomy is considered for a patient with severe symptoms who does not show a reduction in vestibular function with gentamicin. Benzodiazepines and anti-emetics are used for symptomatic control during vertigo episodes. Rehabilitative options for unilateral vestibular weakness include physical therapy and for unilateral hearing loss include conventional hearing aids, contralateral routing of sound (CROS) and osseointegrated hearing aids.

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References and Recommended Reading

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Acknowledgments

A grant from Otonomy to the Johns Hopkins School of Medicine funds this work. The contract is approved and monitored by the institution’s Office of Research Administration, the Conflict of Interest Committee and the Institutional Review Board.

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Conflict of Interest

Jeffrey D. Sharon, Carolina Trevino, and Michael C. Schubert declare no conflicts of interest. John P. Carey declares that he is a site investigator for a clinical trial of OTO-104 for control of vertigo in MD.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Correspondence to Jeffrey D. Sharon MD.

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This article is part of the Topical Collection on Neurologic Ophthalmology and Otology

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Sharon, J.D., Trevino, C., Schubert, M.C. et al. Treatment of Menière’s Disease. Curr Treat Options Neurol 17, 14 (2015). https://doi.org/10.1007/s11940-015-0341-x

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Keywords

  • Meniere’s disease
  • Vertigo
  • Intratympanic steroids
  • Vestibular physical therapy
  • Intratympanic gentamicin
  • Pharmacotherapy for Meniere’s disease
  • Unilateral hearing loss