Recognizing triggers An important part in the management of Meniere’s disease is for the patient to recognize if there is any particular behior or exposure which seems to precipitate an attack. There may a wide variety of causes such as emotional stress, food sensitivities, or allergies. If there are particular triggers, identifying and oiding them is a major step in controlling the disease.
Low salt diet Just as the intake of salt can affect blood pressure, it can affect the pressure of the inner ear fluids. It is the sodium in salt which is to be oided. People with Meniere’s disease will often note that eating a high-sodium meal will be predictably followed by an attack 12 to 48 hours later. A diet with less than 1.5 grams (1500 milligrams) per day of sodium is recommended. This is considerably less than the erage American diet and it requires some determination and planning to follow. There are excellent cookbooks and pamphlets ailable in most bookstores and pharmacies to help with diet planning.
Betahistine Betahistine is an antihistamine commonly prescribed outside the United States for Meniere's Disease and vertigo. It is currently not commercially ailable in the United States, but can be obtained through compounding pharmacies at some cost.
Diuretics Diuretics, or “water pills,” can be used with a low salt diet to further reduce the fluid pressure in the inner ear.
Stress reduction Emotional stress, fatigue, or other illness will precipitate an attack in many patients with Meniere’s disease. Finding ways to oid stress and maintain general good health will often contribute greatly to controlling the attacks. The symptoms of the disease itself are often the source of a great deal of stress, which can itself make the symptoms worse. Professional counseling, or stress-reduction programs are beneficial in many cases. Support groups are ailable for individuals with Meniere’s disease, and publish informational newsletters which are often helpful.
Avoid certain substances Caffeine, alcohol, and smoking are other substances that commonly make Meniere’s disease worse and should be oided.
Treating acute attacks
Vestibular suppressants/ Sedatives Relaxants such as Ativan (lorazepam), Valium (diazepam), or Klonopin (clonazepam) improve the symptoms of an acute attack by three mechanisms: (1) They suppress the balance disturbance of the inner ear by reducing the abnormal signals sent to the brain, (2) they induce sleep, and (3) they reduce the anxiety caused by an attack. They do not act to prevent the fluid pressure problem responsible for the attack, and so only provide symptomatic relief. Less powerful vestibular suppressants, such as Antivert or Dramamine also work in some cases but are often inadequate in a severe attack.
These medicines must often be taken following an anti-emetic (anti-nausea) medication so that they are absorbed. In severe attacks, these medications may be given in injectable form to bring relief. These medications may be helpful for several days following an acute attack, but rarely are needed chronically.
Anti-Emetics Medicines which reduce the sensation of nausea (such as Compazine or Phenergan) can bring considerable relief during an acute attack. Often these are more effective when used as a rectal suppository early in an attack so that the medication may be absorbed and allow additional medications so be taken without being vomited before they can work.
Surgical therapy In the unusual cases where attacks of vertigo are not controlled with behior modification, diet, and medicines, surgical procedures may be highly effective. All of the surgical treatments are aimed at reducing the acute vertigo, and none he been shown to improve the hearing loss or tinnitus (ear noises).
Steroid injection In some patients, an injection of steroids (dexamethasone) into the middle ear can help reduce the severity of the disease. This is not as likely as gentamicin to cause permanent improvement in attacks of vertigo,. However, there is less risk of hearing loss, and in some cases, a steroid injection can help the hearing improve.
Gentamicin injection Gentamicin is normally used as an antibiotic, but it also can be used to selectively eliminate the balance potion of the inner ear while preserving the remaining hearing. This is performed through sequential injections of the gentamicin through the ear drum in the office. The number of injections needed varies, but overall, about 80% of patients will receive some benefit from this treatment.
Endolymphatic sac operation The endolymphatic sac is a portion of the inner ear felt to be central to the origin Meniere’s disease. It is the area where the endolymphatic fluid is reabsorbed, and where the inner ear fluid pressure is regulated. The surgical removal of bone and scar from around this sac allows some patients to better control their inner ear pressure, and so he fewer attacks. About 1/2 to 2/3 of patients who he this operation will improve.
Vestibular nerve section If the balance nerves to the affected ear are surgically divided, the brain will no longer experience the ear’s abnormal bursts of activity during acute attacks. The balance nerves may be cut while preserving hearing in the majority of patients. The procedure is highly effective in the control of acute attacks, with about 95% of patients experiencing relief. However, it is a more involved operation requiring surgery near the brain, and patients usually need to stay in the hospital for several days to a week.
Labyrinthectomy The complete surgical removal of the organ of balance is termed a “labyrinthectomy.” This is as highly effective as the vestibular nerve section, and the operation has fewer significant complications. The disadvantage of this option is that hearing is permanently lost in the operated ear. It is therefore generally reserved for individuals with no useful hearing on the affected side.