By Dr Ananya Mandal, MD
Ménière's disease is a disease of the inner ear and may severely affect the quality of life. There are recurrent attacks of vertigo, tinnitus, hearing loss and feeling of fullness or pressure within the ear.
As the disease progresses the frequency of these sudden, severe and unpredictable attacks reduce but the patient develops a persistent tinnitus and hearing loss.
There is no cure for this disease. According to the Ménière's Society 80% of patients feel their symptoms are relieved by medical treatments and do not require surgery. In about half the patients, the disease eventually affects both ears. (1-7)
Aims of treatment of Ménière's disease
Aims of treating this condition are:
- To provide relief to the symptoms of the attacks
- To reduce the severity and frequency of the attacks
- To prevent hearing loss and improve hearing loss and to reduce the effects of tinnitus on activities of daily living.
Preventive therapies of Ménière's disease
Preventive therapies include:
- Patients are advised a low salt diet and diet without caffeine, chocolate, alcohol and tobacco. They are asked to avoid excess fatigue, stress and anxiety as these may trigger attacks.
- Medication like Betahistine is given 16 mg three times a day to reduce the frequency and severity of attacks.
- Some patients are prescribed diuretics or water pills to reduce the severity of the attacks but these are not usually recommended for use in primary care.
Specific treatments of Ménière's disease
There are specific treatments for different symptoms of Ménière's disease. These include treatments for vertigo and nausea, for inflammation of the ear, for hearing loss and so forth.
Treatments for vertigo and nausea
For reducing symptoms of vertigo and nausea antihistaminics like prochlorperazine, Cinnarizine, Cyclizine or Promethazine are used.
For patients who are vomiting and unable to take oral tablets or pills injections may be administered or the drug may be given in form of gels applied to the mucosa of the mouth (buccal route) etc.
In patients with severe vomiting patient might need admission to a hospital to prevent dehydration.
Treatment for inflammation of the inner ears
Some patients are prescribed steroid injections followed by gradually lowering doses of steroids to reduce the swelling and inflammation within the inner ears.
Treatment for hearing loss
Patients with hearing loss are advised hearing aids. For tinnitus, patients are prescribed various sound therapies and relaxation/distraction techniques. Patients are advised to use ear plugs and avoid loud noise as much as possible.
Surgery as a treatment for Ménière's disease
Surgical therapies are recommended in severe cases. This includes Endolymphatic sac surgery. This surgery involves relieving the fluid pressure in the endolymphatic sac and sigmoid sinus.
Some surgeries aim at dissecting and removing the vestibular nerve that carries the sensation of vertigo to the brain and thus reduces vertigo while preserving hearing.
One of the last surgical options is to remove the membranous labyrinth. This is called Labyrinthectomy. Hearing is also lost in the operated ear.
In yet another method of treatment an antibiotic called gentamicin that is toxic to the ears is selectively injected into the affected ear through the ear drum. It destroys the balance part of the inner ear. There is also a risk of damage to hearing with this therapy.
Other treatments for Ménière's disease
Other treatments for Ménière's disease include:
- An antibiotic called gentamicin that is toxic to the ears is selectively injected into the affected ear through the ear drum. It destroys the balance part of the inner ear. There is also a risk of damage to hearing with this therapy.
- Vestibular rehabilitation programmes are recommended over long term. These involve teaching the patient exercises to improve balance, co-ordination and posture.
- Micropressure therapy is another new therapy recommended by the National Institute for Health and Clinical Excellence (NICE). A small channel or grommet is inserted through the eardrum into the middle ear. It neutralizes the ear pressure on both ends and reduces symptoms.
- Patients with additional anxiety disorders and depressive diseases need additional therapy with medication, counselling and behavioural therapy.
Advice for patients with Ménière's disease
During an attack the patient needs to be protected from injuries as there may be falls. These patients are usually advised against driving, operating heavy machinery, swimming etc.
After the attack the patient usually prefers to sit still. They should be encouraged to move around to promote the other functions of the brain like vision that help in compensating for the loss of balance and maintain posture and balance.
Reviewed by April Cashin-Garbutt, BA Hons (Cantab)