Dyazide; Maxzide; Maxzide-25
Anti-emetic, Anti-nausea and Anti-vertigo drugs
Serc / betahistine
Calcium channel blockers
Stugeron / Cinnarzine
Sodium bicarbonate infusion
Endolymphatic sac decompression
Tympanostomy tube / eardrum
Endolymphatic sac - partial ablation
Vestibular nerve section
Help with maintaining a low-salt diet is available.
Dietary manipulation - Water Intake
Many physicians give little or no guidance with regard to how much water should be consumed. General rules for a healthy diet apply, including eating small, regular meals and keeping water intake up. If the goal of the diuretics and low salt diet is to increase sodium loss from the body, then a normal level of water consumption (8 glasses per day) would help achieve this aim. Some physicians apparently advise their patients to limit water intake, presumably to aid in the dehydrating effect of the diuretic. To my knowledge, there are no data supporting either point of view.
Dietary manipulation - Caffeine restriction
Often recommended, but no known data published to support a direct association with Meniere's
Dietary manipulation - Chocolate restriction
Often recommended, but no known data published to support a direct association with Meniere's
Dietary manipulation - Alcohol restriction
Often recommended, but no known data published to support a direct association with Meniere's
Dietary manipulations - Other
Some patients report that by limiting sugar, MSG (monosodium glutamate) caffeine and/or alcohol their attacks occur less frequently. There is no compelling scientific rationale for why this should be. Therefore, each individual needs to make their own decision of what is appropriate. It is important to be as objective as possible in this assessment. If dietary restriction does not alleviate the symptoms then do not adopt an increasingly restrictive diet. It may be that your form of the disease may not be alleviated by diet alone. It is unrealistic to expect that even the strictest dietary management will prevent Ménière's disease in all patients. The best approach is to keep a diary in which symptoms are rated as onjectively as possible. This can best guide the otologist in the management of their condition. Also, it is important to avoid making "spurious" associations between events and symptoms. For example, an attack following a specific food does not necessarily mean that this food produced the attack. Perhaps the attack could have occurred anyway, even without that type of food. The key is to be objective and to monitor your symptoms over a prolonged period. If any strategy reduces the frequency of the attacks it is logical to maintain that strategy. However, If you maintain a controlled, healthy diet and attacks persist, you should not feel "guilty" that perhaps your diet was not "strict enough". Some patients will not respond simply to dietary managment an no amount of restrictions will help. The key is to try to be objective in your assessment.
Diuretics - General
By increasing urine production, treatment with diuretics contibutes to a "negative sodium balance", which means that more sodium is lost from the body than is eaten in the diet. This contributes to the effects of a low-sodium diet and results in hormone level changes associated with sodium conservation by the body.
Diuretic - Brand Names: Dyazide; Maxzide
Generic name : Triamterene and Hydrochlorothiazide
Drug Class : Antihypertensive; Potassium Sparing Diuretic
Dyazide is a combination of hydrochlorothiazide (diuretic and antihypertensive) and triamterine. Triamterine is a potassium-sparing diuretic, which means that it increases excretion of sodium and chloride in the urine, while conserving potassium.
Diuretic - Brand Names: HCTZ, Esidrix, Oretic, HydroDiuril, Microzide
Generic Name: Hydrochlorothiazide (HCTZ)
Drug class : Thiazide Diuretic; Antihypertensive
HCTZ is one of the diuretic components of Dyazide.
Diuretic - Brand Name: Lasix
Generic Name: Furosemide
Furosemide is loop diuretic, a specific class of diuretics that inhibits reabsorption of sodium and chloride ions not only in the proximal and distal tubules, but also in Henle's loop, thereby increasing the volume of urine excreted. It is also known that stria vascularis in the cochlea (the tissue that secretes endolymph) is highly sensitive to furosemide, although it is not known whether this helps in the action of this diuretic.
Diuretic - Brand Name : Diamox
Generic Name: acetazolamide
Drug Class : Carbonic Anhydrase Inhibitor, Anticonvulsant, Antiglaucoma
Acetazolamide is sometimes prescribed and because of its documented effectiveness in treating glaucoma of the eye (with which endolymphatic hydrops is sometimes compared). However, regulation of endolymph in the inner ear occurs by completely different mechanisms to those in the eye, so that acetazolamide is unlikely to have any direct effect on hydrops in the ear. Acetazolamide also acts as a diuretic and may, by increasing sodium excretion, be beneficial. The action of acetazolamide is different in that it inhibits the enzyme carbonic anhydrase, which influences carbon dioxide, and bicarbonate homeostasis, and may affect pH regulation in some tissues. One study (Brookes and Booth, 1984) reported poor results and a high incidence of side effects with this diuretic.
Anti-emetic, Anti-nausea and Anti-vertigo drugs - General
While most of these drugs are generally aimed at treating the effects of vertigo in Meniere's disease they may also play a role in controlling the disease itself by reducing stress and anxiety.
Anti-nausea - Brand Names : Antivert, Bonine, D-Vert, Dramamine II, Meclicot, Medivert
Generic Name: Meclizine Hydrochloride
Drug Class : Antiemetic; H1 Receptor Blocker (antihistamine)
Meclizine is used to treat the nausea and vomiting associated with motion sickness and vertigo. It is believed to work by decreasing the sensitivity of the body's central nervous system balance centers. It helps manage motion sickness and affects the chemoreceptor trigger zone to control vomiting.
Anti-nausea - Brand Name : Serc
Generic name : betahistine
Drug Class : an H1 binding histamine:
In Europe, Betahistine is tending to replace meclizine as the preferred anti-vertiginous drug.
Betahistine is also reported to increase cochlear blood flow, which may in some way also contibute to the improvement seen in patients. Serc is not available in the USA but generic forms of betahistine may be available by prescription through compounding pharmacies.
Anti-nausea - Brand Name : Phenergan
Generic Name: Promethazine Hydrochloride
Drug class : Tranquilizer, Antiemetic, H1 Receptor Blocker, Phenothiazine
Promethazine controls nausea, vomiting and motion-sickness. An H1-blocking antihistamine with sedative and anti-emetic properties.
Anti-nausea - Brand Names : Dramamine, Vomex
Generic Name : Dimenhydrinate
Drug class : Antiemetic, H1 Receptor Blocker
Dimenhydrinate is an antihistamine used to treat motion sickness, nausea and vomiting. It works by blocking histamine from binding to its receptor, preventing histamine from exerting its effects.
Anti-nausea - Brand Names : Compazine, Stemetil
Generic Name: Prochlorperazine Maleate (Phenothiazine)
Drug class : Tranquilizer; Antiemetic; Antipsychotic
Prochlorperazine belongs to a class of agents called phenothiazines. It is used for the management of psychotic disorders, anxiety and to control emesis (nausea and vomiting). It works by blocking the dopamine receptors in different parts of the brain.
Anti-nausea - Brand Name : Transderm-Scop
Drug class: Anticholinergic Agent, Antiemetic
Transdermal scopolamine is a naturally occurring belladonna alkaloid with anticholinergic properties. It is used to prevent nausea and vomiting associated with motion sickness in adults. It does this by altering stimulation to the central nervous system.
Anti-nausea - Brand Names : Vistaril
Generic Name: Hydroxyzine Pamoate
Drug class :Antihistamine, Tranquilizer, Antiemetic, H1 Receptor Blocker Hydroxyzine pamoate is an antihistamine used to treat a variety of allergic conditions. It is even used preoperatively to help induce sleep. It works by blocking the action of histamine, an important nflammatory mediator in the body, from binding to its receptor and exerting its effects.
Anti-nausea - Brand Names : Gravol
No information available
Anti-nausea - Brand Names : Torecan
Generic Name : Thiethylperazine Maleate
Drug class : Antiemetic, Phenothiazine
Thiethylperazine maleate belongs to a class of antiemetic agents called phenothiazines. It is used to treat severe nausea and vomiting in certain patients. Thiethylperazine works by triggering brain chemoreceptors to alter the message to the vomit center in the brain.
Anti-anxiety drugs - General
There is no doubt that stress is an important factor in triggering Meniere's attacks. It is well documented that stress changes some hormone levels (especially of the corticosteroids). Therefore treating the stress may itself lead to an improvement in the patient. So-called "life-stress situations" which commonly precede attacks include personal antagonism and conflicts, sexual conflicts death of a close relative, social, educational or financial problems and finally, fear of future attacks. The greater the fear of attacks, the more frequent and severe they become and vice versa (the "viscious cycle"). The use of anti-anxiety drugs is aimed at breaking this cycle.
Anti-anxiety Brand names : Valium, Di Tran, Diazepam Intensol
Generic Name: Diazepam (Benzodiazepine)
Drug class : Anticonvulsant, Antianxiety, Skeletal Muscle Relaxant
Diazepam is a benzodiazepine, a type of central nervous system (CNS) depressant (medicine that slows down the nervous system). It is used to treat several disorders including panic disorder, muscle spasms, anxiety, and alcohol withdrawal. It is also used in combination with other anti-seizure medications to treat seizure disorders.
Anti-anxiety Brand names : Ativan, Lorazepam Intensol
Generic Name : Lorazepam
Drug class : Benzodiazepine, Antianxiety
Lorazepam is a benzodiazepine, a type of central nervous system (CNS) depressant (medicine that slows down the nervous system). It is used to treat anxiety, anxiety associated with depression, or insomnia.
Anti-anxiety Brand names : Xanax, Alprazolam Intensol
Generic Name : Alprazolam
Drug class : Benzodiazepine, Antianxiety Alprazolam is a benzodiazepine, a type of central nervous system (CNS) depressant (medicine that slows down the nervous system). It is used to treat anxiety, anxiety associated with depression and panic disorders.
Anti-anxiety Brand name : Thorazine
Generic Name: Chlorpromazine Hydrochloride (Phenothiazine) Drug class : Antipsychotic, Tranquilizer; Antiemetic Chlorpromazine belongs to a class of antipsychotic drugs called phenothiazines. It is used to treat schizophrenia as well as for the control of anxiety or agitation in certain patients, severe nausea and vomiting and severe hiccups. Chlorpromazine works in the brain and at all levels of the central nervous system to exert sedative and anti-nausea activity.
Steroids - General
Some physicians prescribe steroids which are synthetic glucocorticoids (normally sysnthesised by the adrenal glands). The benefit seen by some patients has been attributed to suppression of an autoimmune response, and has been used to support the concept that Meniere's disease may arise from some form of autoimmunity. However, glucocorticoids have a vast array of effects on the body, affecting carbohydrate and protein metabolism, lipid metabolism, electrolyte balance, inflammatory responses and immune responses. In addition, glucocorticoid receptors has been demonstrated in tissues of the inner ear (Rarey et al., 1993) raising the possibility that these steroids may have a direct effect on fluid homeostasis in the ear. It is therefore impossible at the present time to know exactly which of the effects of these steroids is important in relieving the symptoms of Meniere's disease.
Steroid - Prednisone
Brand Names : Deltasone, Meticorten, Orasone Generic Name: Prednisone
Drug class : Glucocorticoid Prednisone is a glucocorticoid steroid used to treat a variety of inflammatory conditions, including asthma, allergic reactions and autoimmune diseases (such as lupus). It works by altering how the immune system responds to certain stimuli. It may also act directly on fluid homeostasis in the inner ear by interacting with glucocorticoid receptors in the ear.
Steroid - Cortisone
Generic Name: Cortisone Acetate
Drug class : Glucocorticoid
Cortisone acetate is a glucocorticoid used to treat a variety of inflammatory conditions, including the management of adrenocortical insufficiency (when the body lacks glucocorticoids). Cortisone may act to supplement the body's natural glucocorticoid stores or alter how the immune system responds to certain stimuli
Steroid - Dexamethasone
Brand Names: Adrenocot, Dalalone, Decadron, Decaject, Dekasol, Dexacorten,Dexasone,Dexim, Dexone, Hexadrol, Medidex, Primethasone; Solurex
Generic Name : Dexamethasone Sodium Phosphate or dexamethasone acetate
Drug class : Glucocorticoid
Dexamethasone belongs to a class of anti-inflammatory agents called corticosteroids. It is used to treat various inflammatory conditions. It works by altering the way the immune system responds to certain stimuli. Dexamethasone is sometimes given locally to the cochlea (by injection through the eardrum into the middle ear space) in conjunction with intravenous administration. This allows higher drug levels to be achieved in the cochlea. Although initial results look promising, this approach needs to be replicated in other centers. At present some physicians regard the efficacy of intratympanic steriods as an effective long term treatment for Meniere's unproven.
Anti-histamine - Brand Name : Hismanal
Generic Name: Astemizole
Drug class : Non-Sedating Antihistamine; H1 Receptor Blocker
Hismanal is no longer regarded as a good choice of therapy. There have been rare cases of severe cardiovascular events when astemizole was taken in high doses or in combination with some specific other drugs. The manufacturer discontinued making the product in June 1999. Patients should contact their doctors to discuss alternative treatment.
Anti-histamine - Brand Name: Claritin
Generic Name: Loratadine
Drug class: Non-Sedating Antihistamine; H1 Receptor Blocker
There are no studies in which the efficacy of this drug has been assessed in Meniere's patients
Anti-histamine - Brand Name : Allegra
Generic Name: Fexofenadine Hydrochloride
Drug class : Non-Sedating Antihistamine, H1 Receptor Blocker There are no studies in which the efficacy of this drug has been assessed in Meniere's patients
Calcium channel blocker - Stugeron / Cinnarzine
Cinnarzine is a calcium channel blocker which is not presently available in the USA. Exactly how it influences Meniere's symptoms and/or function of the ear is not known. Studies in animals with endolymphatic hydrops have shown the endolymph calcium level to be elevated. Limited measurements of endolymph sampled from Meniere's patients also shows a high calcium level. This raises the possibility that a calcium disturbance may contibute to the symptoms of Ménière's disease. Some physicians, especially in those in Europe, have been using calcium channel blockers to treat Ménière's disease, including, Flunarizine, Nimodipine and Cinnarzine. Cinnarzine appears to induce fewer side-effects.
Vasoactive drug - Niacin
Some physicians prescribe niacin for Meniere's patients. In a search of the MEDLINE database for papers in the last 5 years which mentioned Meniere's and niacin, there were no citations. In a recent symposium on Meniere's disease the use of niacin as a treatment was never mentioned. We conclude that niacin therapy is not widely used to treat Meniere's. Niacin (nicotinic acid) lowers the level of lipids circulating in the blood. LDL-cholesterol is reduced and HDL-cholesterol is increased. Niacin therapy may be appropriate in patients showing abnormal blood lipids, but probably has no direct effect on the Meniere's disease itself..
Osmotic Agent - Glycerol
Glycerol is given to patients with Ménière's disease as part of some diagnostic tests. The effect is very short-term (hours) and glycerol is not used as a long-term therapy. In addition, glycerol somestimes has the side effect of producing nausea and headache.
Osmotic Agent - Urea
Urea is given to patients with Ménière's disease as part of some diagnostic tests. Its effects are very short-term (hours) and urea not used as a long-term therapy. Some groups are researching giving urea at the first sign of an attack, to reduce the attack severity. However, urea is not well accepted by patients due to the taste and the side effects, which can include nausea and headache.
Osmotic Agent - Isosorbide
Isosorbide is used as an osmotic agent, which produces diuresis (production of urine). Clinically, isosorbide is better accepted than urea and glycerol as it tastes better and does not have the side effects. It has been reported that over an 8 week period, isosorbide treatment improved hearing in 38% of the patients in one study (Kakigi et al, 1995) but no reduction in vertigo was reported.
Ototoxic Antibiotics - General
In Meniere's disease, antibiotics are not used for their conventional, bacteriocidal purpose. Instead, the ability of specific antibiotics to selectively damage the sensory hair cells of the vestibular system is used. This can also be described as a chemical labyrinthectomy, which represents a non-surgical, method to reduce the sensitivity of the vestibular system. By impairing or destroying these cells, the brain is no longer sent "incorrect" information that the head is rotating.
The techniques rely on the fact that for antibiotics such as gentamicin, the sensory cells of the vestibular system are more sensitive to damage than are the cells of the cochlea. This gives the opportunity, at the right dose, for vestibular function to be reduced without damaging hearing. The antibiotic is usually injected into the middle ear space through the eardrum, and enters the inner ear through the round and oval windows. This method can be effective, but in practice it is difficult to achieve vestibular ablation without causing some damage to hearing. A number of groups are presently researching the best regimen of antibiotic applications. Olsen et al. (1995) reported that best results were obtained with 2-4 applications to the middle ear, with a greater liklihood of hearing loss if more treatments were given. One common approach is to "titrate" the number of treatments to the patients symptoms, using just enough to alleviate vertigo without necessarily destroying all vestibular function.
Ototoxic Antibiotic - Gentamicin
Gentamicin is most widely used for the selective ablation of the vestibular system of one ear. It is administered by injecting it through the eardum into the middle ear space. From there it diffuses into the fluids of the inner ear. Usually, repeated injections are performed over a period of weeks, which allows hearing function to be monitored to minimize the chances of further hearing loss.
Ototoxic Antibiotic - Streptomycin
In cases of bilateral disease some physicians administer streptomycin intramuscularly at a dose which is titrated to suppress labyrinthine function. One of the problems associated with bilateral ablation of the labyrinths is a condition called oscillopsia. This is perceived as an oscillation of the visual field, which can be as disturbing to the patient as vertigo. The goal with streptomycin administration is to reduce the sensitivity of the labyriths without totally ablating them. One study has reported that permanent dysequilibrium may be observed in 47% of cases treated with this streptomycin titration method.
Nutritional supplements - Ginko biloba
While the use of Ginko biloba has been advocated by some to help Meniere's patients, there is no scientific evidence demonstrating any effect on symptoms or on the ear. It probably will not do any harm, but is more likely to be a waste of money.
Nutritional supplements - Ginger
Some find that use of ginger helps reduce nausea.
Nutritional supplements - Lipoflavinoids
Some dietary supplements are being marketed containing flavinoids which are claimed to have a beneficial theraputic effect in Ménière's patients. The scientific data supporting such claims is extemely weak and the medical community would generally not accept the fact that Ménière's disease arises from a dietary deficiency. If this type of supplement appeals to you, it will probably not do any harm, except maybe to your wallet.
Miscellaneous - Sodium bicarbonate infusion
Some Japanese physicians administer intravenous sodium bicarbonate as a treatment for an acute vestibular Meniere's attack. This therapy is not presently used in the USA
Miscellaneous - Acupuncture
Since stress is a precipitating factor in Meniere's disease, there are many approaches by which symptoms can be reduced by stress reduction. Acupuncture probably falls in this category.
Miscellaneous - Chiropractic manipulations
Since stress is a precipitating factor in Meniere's disease, there are many approaches by which symptoms can be reduced by stress reduction. Chiropractic manipulations probably fall in this category.
Surgical Procedures - Anesthetics
It has been suggested that the improvement seen in patients following ear surgery may in part be due to the general anesthesia used. Furthermore, some patients benefit from anesthesia without surgery. Gates (1999) reported that in the 30% of Meniere's patients who did not repond to low-salt diet, diuretics and stress reduction, 60% of these patients gained relief from vertigo by one injection of the anesthetic, Innovar. This has been attributed to a long-lasting depression of the vestibular system by some anesthetics.
Surgical Procedures - Endolymphatic shunt
Endolymphatic sac surgery is still relatively controversial. Based on a published study, many physicians regard endolymphatic sac surgery as a "placebo" surgery (i.e. the patient gets the same outcome whether or not the sac is acutally shunted) and will no longer perform it. One physician has described the procedure as "at best non-specific and at worst of no value". Others regard surgery of the sac to as a valuable "intermediate step" between non-surgical therapies and the more invasive procedure of vestibular nerve section. If you are looking for "intermediate steps" you may want to consider having a tympanostomy tube inserted before committing to shunt surgery, as the numbers of patients gaining benefit appears to be similar for the two procedures.
This involves placing a tube between the endolymphatic sac and the cranium
This involves placing a tube between the endolymphatic sac and the mastoid cavity of the middle ear. This procedure is generally used to avoid potential problems of opening the cranium in the endolymph-subarachnoid shunt.
Surgical Procedures - Endolymphatic sac decompression
This surgery involves drilling away the bone overlying the endolymphatic sac to make a larger "cavity" for the sac to occupy.
Surgical Procedures - Insertion of a tympanostomy tube through the eardrum
This is a relatively minor procedure which is widely used in children and adults for the relief of middle-ear infections. The purpose of the tube is to maintain a tiny hole through the eardrum. Although the medical community has been skeptical that this treatment would have any bearing on Meniere's disease, many physicians are finding that they are very effective with success rates as good as endolymphatic shunt surgery. The published studies indicate a high proportion of Ménière's patients get relief from vertigo by this procedure. Furthermore, a recent study in animals has provided scientific support that the procedure is effective, finding that hydrops developed to a lesser degree when the eardrum was perforated. However, some physicians remain unconvinced and there is as much controversy on this issue, as there is with endolymphtic shunts. It should be emphasized that the apparent "fullness in the ear" described by Meniere's patients does not arise from abnormal pressure in the middle ear space so the reason for the tube is not to release a middle ear pressure. In our present research we are finding there are a number of mechanisms by which perforation of the tympanic membrane could affect the cochlear fluids. For those considering surgical options, this may be something to try before other, more invasive, surgeries are considered.
Surgical Procedures - Endolymphatic sac : partial ablation
It has now been shown that outcomes equal or better than other sac procedures can be obtained by partially ablating (destroying) the distal region of the endolymphatic sac. (Gibson 1999)
Surgical Procedures - Sacculotomy, Cochleosacculotomy
These are also relatively minor surgical procedures which involve perforation of the saccule through the stapes footplate (sacculotomy) or through the round window, via the basilar membrane (cochleosacculotomy). While the procedures showed some benefit in reducing vertigo, there is considerably greater risk to hearing by these procedures than by other surgical procedures. As a result, these procedures are not widely used.
Surgical Procedures - Vestibular nerve section
This is a highly invasive surgery which can dramatically cure severe cases of disabling vertigo. The goal of the surgery is to cut the nerve from the vestibular apparatus, while leaving the auditory nerve intact, thereby preserving hearing. During the recovery period, the brain adapts to manage without vestibular input from the operated side, so that normal activity can be resumed. There are some concerns that after this procedure, patients may not be totally asymptomatic (Mattox 1999) Although the vertigo attacks may be cured , it is fairly common for chronic disequilibrium or imbalance to persist after the procedure.
Surgical Procedures - Labyrinthectomy
Surgical ablation of either a portion or the entire labyrinth can be performed by a trans-canal or post-auricular approach. These procedures are normally only performed when there is no useful hearing in the affected ear, since collateral damage to the cochlea may produce significant hearing loss.
Page generated by: Alec N. Salt, Ph.D.,
Cochlear Fluids Research Laboratory,
Washington University, St. Louis