Skip to main content
SpringerLink
Log in

Menière’s Disease

Pathophysiology and Treatment

  • Therapy in Practice
  • Published:
Drugs Aims and scope Submit manuscript

Abstract

Menière’s disease is defined by the association of 4 symptoms: vertigo attacks, fluctuating hearing loss, tinnitus and an auricular plenitude sensation. The pathophysiology is commonly explained by a distension of membranous labyrinth by the endolymph, equally called endolymphatic hydrops. Recent studies also tend to relate the disease to immune mechanisms.

The treatment is medical in the majority of patients but there is no international consensus on the management of the different stages of Menière’s disease. Regarding the lack of clinical studies clearly demonstrating the effectiveness of a certain therapy or another, the recommendations are usually based on the empirical experience of practitioners and on the observation of a marked amelioration at 2 years of treatment in the majority of patients.

The treatment of the acute phase of Menière’s disease is basically symptomatic. Vestibular suppressant drugs have a well-established record in controlling acute attacks of vertigo. Most have variable anticholinergic, anti-emetic and vestibular sedative effects. If necessary, the administration of benzodiazepines will help to alleviate anxiety.

Long term management of Menière’s disease includes a low salt diet, the use of diuretics in the post-crisis phase, and the very common use in Europe of histaminergic agents. Corticosteroids are used in bilateral forms of Menière’s disease, particularly if an autoimmune basis is suspected. All authors insist on the interest and the importance of regular follow-up, especially with regard to the psychological status and responsiveness to treatment of the patient.

Surgical indications are rare and the least invasive procedures are used first. The choice of the procedure should take into consideration the need to preserve the auditory function of the patient.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Nadol Jr JB. Medical management of Menière’ s syndrome. In:Harris JP, editor. Menière’ s disease. The Hague: Kugler Publications, 1999: 341–2

    Google Scholar 

  2. Gates GA. Menière’s disease: medical therapy. In: Harris JP, editor. Menière’ s disease. The Hague: Kugler Publications, 1999: 329–40

    Google Scholar 

  3. Hallpike CS, Cairns H. Observations on the pathology of Menière’s syndrome. J Laryngol Otol 1938; 53: 625–55

    Article  Google Scholar 

  4. Yamakawa K. Uber die pathologische Veranderung bei einem Menière-Kranken. J Otolaryngol Jpn 1938; 44: 2310–2

    Google Scholar 

  5. Marchbanks R. Why monitor perilymphatic pressure in Menière’ s disease? Acta Otolaryngol (Stockh) 1997; Suppl. 526: 28

    Google Scholar 

  6. Qvortrup K, Rostgaard J, Holstein-Rathlou NH. The inner ear produces a natriuretic hormone. Am J Physiol 1996; 270: FI073–7

    Google Scholar 

  7. Takeda T, Kakigi A, Saito H. Antidiuretic hormone (ADH) and endolymphatic hydrops. Acta Otolaryngol 1997; Suppl. 526: 27–9

    Google Scholar 

  8. Sterkers O, Ferrari E, Amiel C. Inter and intracomportmental osmotic gradients within the rat cochlea. Am J Physiol 1984; 247: F602–6

    PubMed  CAS  Google Scholar 

  9. Sterkers O, Ferrari E, Amiel C. Production of inner ear fluid. Physiol Rev 1988; 68: 1083–128

    PubMed  CAS  Google Scholar 

  10. Kimura RS. Animal models of endolymphatic hydrops. Am J Otolaryngol 1982; 3: 447–51

    Article  PubMed  CAS  Google Scholar 

  11. Dornhoffer JL, Kaufman Arenberg I. Immune mechanisms in Menière’s syndrome. Otolaryngol Clin North Am 1997; 30: 1017–26

    PubMed  CAS  Google Scholar 

  12. Evans KL, Baldwin DL, Bainbridge D, et al. Immune status in patients with Menière’s disease. Arch Otorhinolaryngol 1988; 245: 287–92

    Article  PubMed  CAS  Google Scholar 

  13. Dornhoffer JL, Waner M, Arenberg IK, et al. Immunoperoxydase study of the endolymphatic sac in Menière’s disease. Laryngoscope 1993; 103: 1027–34

    Article  PubMed  CAS  Google Scholar 

  14. Alleman AM, Dornhoffer JL, Kaufman Arenberg I, et al. Demonstration of autoantibodies to the endolymphatic sac in Menière’s disease. Laryngoscope 1997; 107: 211–5

    Article  PubMed  CAS  Google Scholar 

  15. Lawrence M, McCabe BF. Inner ear mechanics and deafness: special considerations of Menière’s syndrome. JAMA 1959; 171: 1927–32

    Article  CAS  Google Scholar 

  16. Tonndorf J. Vestibular signs and symptoms in Menière’s disorder: mechanical considerations. Acta Otolaryngol (Stockh) 1983; 95: 424–30

    Article  Google Scholar 

  17. Schwartz JC. Histamine receptors in brain. Life Sci 1979; 25: 895–912

    Article  PubMed  CAS  Google Scholar 

  18. Arrang JM, Garbarg M, Schwartz JC. Auto-inhibition of brain histamine release mediated by a novel class (H3) of histamine receptors. Nature 1983; 302: 832–7

    Article  PubMed  CAS  Google Scholar 

  19. Kirsten EB, Sharma JM. Microiontophoresis of acetylcholine, histamine and their antagonists on neurons in the medial and lateral vestibular nuclei of the cat. Neuropharmacology 1976; 15: 743–53

    Article  PubMed  CAS  Google Scholar 

  20. Lacour M, Tighilet B. Vestibular compensation in the cat: the role of the histaminergic system. Acta Otolaryngol (Stockh) 2000; Suppl. 544: 15–8

    Article  CAS  Google Scholar 

  21. Wamsley JK, Lewis MS, Young WS, et al. Autoradiographic localization of cholinergic receptors in rat brainstem. J Neurosci 1981; 1: 176–91

    PubMed  CAS  Google Scholar 

  22. Dederding D. Clinical and experimental examinations in patients suffering from Menière: including a study of the problem of bone conduction. Acta Otolaryngol (Stockh) 1929; Suppl. 10: 1–156

    Google Scholar 

  23. Furstenberg AC, Lashmet FH, Lathrop FD. Menière’s syptom complex: medical treatment. Ann Otolaryngol Rhinol Laryngol 1934; 43: 1035–47

    Google Scholar 

  24. Colletti V. Medical treatment in Menière’s disease: Avoiding vestibular neurectomy and facilitating postoperative compensation. Acta Otolaryngol (Stockh) 2000; Suppl. 544: 27–33

    Article  CAS  Google Scholar 

  25. Boles R, Rice DH, Hybels R, et al. Conservative management of Menière’s disease: Furstenberg regimen revisited. An Otolaryngol Rhinol Laryngol 1975; 84: 513–7

    CAS  Google Scholar 

  26. McCabe B, Sekitani T, Tyy J. Drugs effects on labyrinthectomy nystagmus. Arch Otolaryngol 1973; 98: 309–14

    Google Scholar 

  27. Baloh R. The dizzy patient, symptomatic treatment of vertigo. Postgrad Med 1983; 1973: 317–24

    Google Scholar 

  28. Hain TC. Treatment of vertigo. Neurologist 1995; 1: 1925–33

    Google Scholar 

  29. Haefely W. The GAB AA benzodiazepine receptor: biology and pharmacology. In: Burrows G, Roth M, Noyes R, editors. The neurobiology of anxiety. Handbook of anxiety. Amsterdam: Elsevier, 1990: 165–88

    Google Scholar 

  30. Schaefer K, Meyer D. Aspects of vestibular compensation in guinea pigs. In: Flohr H, Precht W, editors. Lesion-induced neuronal plasticity in sensorimotor system. Berlin: Springer, 1981: 197–207

    Google Scholar 

  31. Slattery WH, Fayaad JN. Medical treatment of Menière’s disease. Otorhinologic Clin North Am Dec 1997;30(6): 1027–37

    Google Scholar 

  32. Morrison AW. Medical management of Menière’s disease. In: Harris JP, editor. Menière’ s disease. The Hague: Kugler Publications, 1999: 347

    Google Scholar 

  33. Claes J, Van de Heyning PH. A review of medical treatment for Menière’s disease. Acta Otolaryngol (Stockh) 2000; Suppl. 544: 34–9

    Article  CAS  Google Scholar 

  34. Arrang JM, Garbarg M, Quach TT, et al. Actions of betahistine at histamine receptors in the brain. Eur J Pharmacol 1985; 111: 73–84

    Article  PubMed  CAS  Google Scholar 

  35. Tighilet B, Leonard J, Lacour M. Betahistine dihydrochloride treatment facilitates vestibular compensation in the cat. J Vest Res 1995; 5: 53–66

    Article  CAS  Google Scholar 

  36. Laurikainen EA, Miller JM, Quirk WS, et al. Betahistine-induced vascular effects in the rat cochlea. Am J Otol 1993; 14(1): 24–30

    Article  PubMed  CAS  Google Scholar 

  37. Laurikainen EA, Miller JM, Neuronal regulation of cochlear blood flow in the guinea-pig. J Physiol 1994; 480(3): 563–73

    PubMed  CAS  Google Scholar 

  38. Bertrand RA. Long-term evaluation of the treatment of Menière’s disease with betahistine hydrochloride. Adv Otorhinolaryngol 1982; 28: 104–10

    PubMed  CAS  Google Scholar 

  39. Oosterveld WJ. Betahistine dihydrochloride in the treatment of vertigo of peripheral vestibular origin. A double blind placebo-controlled study. J Laryngol Otol 1984; 98: 37–41

    Article  PubMed  CAS  Google Scholar 

  40. Oosterveld WJ, Blijleven W, Van Elferen LWM. Betahistine versus placebo in paroxysmal vertigo, a double blind trial. J Drug Ther Res 1989; 14(4): 122–6

    Google Scholar 

  41. Fischer AJEM, Van Elferen LWM. Betahistine in the treatment of paroxysmal attacks of vertigo: a double blind trial. J Drug Ther Res 1985; 10: 9

    Google Scholar 

  42. Fraysse B, Bebear JP, Dubreuil C, et al. Betahistine-dihydrochloride versus flunarizine. A double-blind study on recurrent vertigo with or without cochlear syndrome typical of Menière’ s disease. Acta Otolaryngol (Stockh) 1991; Suppl. 490: 1–10

    Article  CAS  Google Scholar 

  43. Holmes OR, A study of the efficacy of betahistine in Menière’ s syndrome. Acta Otolaryngol (Stockh) 1970; Suppl. 305: 70–9

    Google Scholar 

  44. Weintraub J, Kaufman I, Arenberg IK, et al. The efficacy of ‘conservative’ medical regimens on the rate of hearing loss in Menière’s syndrome: a retrospective computerized statistical analysis. Laryngoscope 1976; 86: 1391–6

    Article  PubMed  CAS  Google Scholar 

  45. Betts T, Harris D, Gadd E. The effects of 2 anti-vertigo drugs (betahistine and prochlorperazine) on driving skills. Br J Clin Pharmacol 1991; 32: 445–8

    Article  Google Scholar 

  46. Sajyadi H, Paparella M. How do I do it: medical management of Menière’s disease. In: Harris JP,editor. Menière’s disease. The Hague: Kugler Publications, 1999: 343–5

    Google Scholar 

  47. Jackson CG, Glasscock ME, Davis WE, et al. Medical management of Menière’s disease. Ann Otol Rhinol Laryngol 1981; 90: 142–7

    PubMed  CAS  Google Scholar 

  48. Ruckenstein MJ, Rutka JA, Hawke M. The treatment of Menière’s disease: Torok revisited. Laryngoscope Feb 1991; 101: 211–8

    CAS  Google Scholar 

  49. Klokhoff I, Lindblom U. Menière’ s disease and hydrochlorothiazide: a critical analysis of symptoms and therapeutic effects. Acta Otolaryngol 1967; 63: 347–65

    Article  Google Scholar 

  50. Klokhoff I, Lindblom U, Stahle J. Diuretic treatment of Menière’s disease: Arch Otolaryngol 1974; 100: 262–5

    Article  Google Scholar 

  51. Jackson CG, Glasscock ME, Davis WE, et al. Medical management of Menière’s disease. Ann Otol Rhinol Laryngol 1981; 90: 142–7

    PubMed  CAS  Google Scholar 

  52. Van Deelen GW, Huizing EH. The use of a diuretic (Dyazide) in the treatment of Menière’s disease. ORL 1986; 48: 282–7

    Article  Google Scholar 

  53. Corvera J, Corvera G. Long-term effects of acetazolamide on the hearing loss of Menière’s disease. Am J Otol 1989; 10: 142–5

    PubMed  CAS  Google Scholar 

  54. Brookes GB. Medical management of Menières’s disease. Ear Nose Throat J 1997; 76(9): 634–40

    PubMed  CAS  Google Scholar 

  55. Kakigi A, Takeda T, Saito H, et al. Effect of isosorbide on hearing loss due to endolymphatic hydrops. Acta Otolaryngol (Stockh) 1995; Suppl. 519: 223–6

    Article  CAS  Google Scholar 

  56. Rascol O, Hain CT, Brefel C, et al. Antivertigo medications and drug-induced vertigo. Drugs 1996; 50(5): 777–91

    Article  Google Scholar 

  57. Hirsch BE, Kamerer DB. Role of chemical labyrinthectomy in the treatment of Menière’ s disease. Otolaryngol Clin North Am 1997; 30(6): 1039–49

    PubMed  CAS  Google Scholar 

  58. Kaasinen S, Pyykko I, Ishizaki H, et al. Intratympanic gentamicin in Menière’s disease. Acta Otolaryngol (Stockh) 1998; 118: 294–98

    Article  CAS  Google Scholar 

  59. Graham MD, Sataloff RT, Kemink JL. Titration streptomycin therapy for bilateral Menière’s disease: a preliminary report. Otolaryngol Head Neck Surg 1984; 92: 440–7

    PubMed  CAS  Google Scholar 

  60. Gates GA. Innovar treatment for Menière’s disease. Acta Otolaryngol (Stockh) 1999; 119: 189–93

    Article  CAS  Google Scholar 

  61. Rarey KE, Curtis LM, ten Cate WJ. Tissue specific levels of glucocorticoid receptor within the rat inner ear. Hear Res 1993; 64(2): 205–10

    Article  PubMed  CAS  Google Scholar 

  62. Itoh A, Sakatu F. Treatment of vestibular disorders. Acta Laryngolog (Stockh) 1991; Suppl. 481: 617–23

    Article  CAS  Google Scholar 

  63. Portmann G. Vertigo: surgical treatment by opening the saccus endolymphaticus. Arch Otolaryngol 1927; 6: 301–19

    Google Scholar 

  64. Thomsen J, Bretlau P, Tos M, et al. Endolymphatic sac-mastoid shunt surgery, a non specific treatment modality? Ann Otol Rhinol Laryngol 1986; 95: 32–5

    PubMed  CAS  Google Scholar 

  65. Montandon P, Guillemin P, Hausler R. Prevention of vertigo in Menière’s syndrome by means of translympanic ventillation tubes. ORL J Otol Rhinol Laryngol Relat Spec 1988; 50: 377–81

    Article  CAS  Google Scholar 

  66. Thomsen J, Bonding P, Becker B, et al. The non-specific effect of endolymphatic sac surgery in treatment of Menière’ s disease. Acta Otolaryngol (Stockh) 1998; 118: 769–73

    Article  CAS  Google Scholar 

  67. Andrews JC, Strelioff D. Modulation of inner ear pressure in experimental endolymphatic hydrops. Otolaryngol Head Neck Surg 1994; 110: 162–7

    Google Scholar 

Download references

Acknowledgements

The authors thank Dr Robert Marchbanks, PhD for giving his permission to reproduce figure 1.

Author information

Authors and Affiliations

  1. Service d’Explorations Fonctionnelles ORL et Audiophonologiques, Pavillon U, Hôpital Edouard Herriot, Place d’Arsonval, 69437, Lyon Cedex O3, France

    Hung Thai-Van

  2. Service d’ORL et Otoneurologie, Hôpital Purpan, Toulouse, France

    Marie-José Bounaix & Bernard Fraysse

Authors
  1. Hung Thai-Van
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marie-José Bounaix
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bernard Fraysse
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hung Thai-Van.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Thai-Van, H., Bounaix, MJ. & Fraysse, B. Menière’s Disease. Drugs 61, 1089–1102 (2001). https://doi.org/10.2165/00003495-200161080-00005

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00003495-200161080-00005

Keywords

Search

Navigation