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Medical treatment

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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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)

Reference:


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