Treatment of Menière’s Disease

Jeffrey D. Sharon, Carolina Trevino, Michael C Schubert, John P Carey

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
JournalCurrent Treatment Options in Neurology
Volume17
Issue number4
DOIs
StatePublished - 2015

Fingerprint

Vertigo
Hearing Aids
Gentamicins
Betahistine
Labyrinth Diseases
Unilateral Hearing Loss
Endolymphatic Sac
Vestibular Nerve
Sodium-Restricted Diet
Therapeutics
Semicircular Canals
Audiometry
Antiemetics
Lyme Disease
Tinnitus
Sensorineural Hearing Loss
Temporal Bone
Caffeine
Migraine Disorders
Benzodiazepines

Keywords

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

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Treatment of Menière’s Disease. / Sharon, Jeffrey D.; Trevino, Carolina; Schubert, Michael C; Carey, John P.

In: Current Treatment Options in Neurology, Vol. 17, No. 4, 2015.

Research output: Contribution to journalArticle

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