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Last Modified Wednesday, April 02, 2014


Treatment of Meniere's Disease
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If "it" helps you, "it" helps you, no matter what "it" is.
That doesn't mean that "it" will help anyone else.
 

Table of Contents

Treatments are and always have been listed here in approximate order
of least invasive, least costly, increasing to most invasive, most costly.

  •  There is no cure. 
    • There is no known cause of Meniere's Disease, there is no known cure for Meniere's Disease, and there is no cure on the horizon.  That's not "negative thinking"; that's simply the fact of the matter and there is no point in denying it or offering false or gratuitous hope.  Click here to see the latest research.  The good news is that Meniere's Disease is not fatal, that there are many possible "symptomatic" treatments (treatments for the symptoms) with which patients can try to lessen or at least manage their symptoms, and that some patients experience temporary spontaneous remissions of varying periods of time.  However, some patients are unresponsive to virtually all treatments, including invasive surgery, and will become disabled.  See this and other pages of this website for further information.
  • Treatment in brief.
    • Most, but not all, treatments are for symptoms believed to be caused by excess endolymphatic fluid.  Unless otherwise indicated, the treatments described below appear to be founded on the theory that Meniere's Disease symptoms result from excess endolymphatic fluid in the inner ear ("idiopathic endolymphatic hydrops"). While this is the prevailing theory, it is not the definitive theory or the only theory.
    • Strategies for obtaining treatment.
      • Sometimes patients are confounded in their quest for treatment because there is no qualified doctor in their town.  The solution to this problem is simple:  go out of town.
        • Visit our doctors page for strategies on obtaining a treatment plan from an out-of-town specialist who coordinates treatment with your local doctor.
  • Which treatments work.
    • No one treatment works for everyone, yet every treatment seems to work for someone.  We each seem to respond differently to various treatments.  Some patients are nearly symptom-free just by observing a low-sodium diet (see below). Other patients may need more complex and/or more invasive treatment.  Other patients seem unresponsive to any treatment — even invasive surgery.
    • The bottom line:  each patient tries to find the treatment (or treatments) that works best for each one of us.
    • Our lay and inexpert speculation: perhaps there are ten (or more or fewer) currently unknown diseases that each have the same symptoms as what we now call "Meniere's Disease," and we each have one (or perhaps two or three) of the ten (or more or fewer) of the currently unknown diseases. *IF* this is true, then ten patients could be diagnosed with "Meniere's Disease," yet each one could have a different disease, and each one could respond differently to various treatments.
  • Note on temporary spontaneous remission.    While not a "treatment," some patients experience temporary unexpected ("spontaneous") remission (cessation or reduction in symptoms) lasting days, weeks, months, or even years.  There is no way to determine who will, or who won't, experience temporary spontaneous remissions, and there is no way to determine how long a temporary spontaneous remission might last.
  • Treatment though clinical trials (clinical studies).
    • What is a clinical trial?  Click here:  U.S. National Institutes of Health.
    • The U.S. government has a website for information on clinical trials:  www.clinicaltrials.gov.
      • Click here to search clinicaltrials.gov for clinical trials related to Meniere's Disease.  This link is at the top of each of our pages.
      • These clinical trials are usually conducted by the NIH (National Institutes of Health).  Clinical trials (clinical studies) are usually "controlled."  This means that there are two groups, the test group and the control group.  The test group is treated in some way.  The control group is "pretend-treated," usually with a placebo ("fake" drug).  Such studies may last one year, more or less.  The results of both groups are compared to see whether patients in the test group improved significantly compared to the control group.  You might or might not like to participate in a controlled clinical trial.  Remember, in a controlled trial, one group  will always be given placebo ("fake") treatment.  However, control groups are necessary in research and patients in the control group make very useful contributions to medical science.  If you are interested in participating in a clinical trial, talk to your doctor.
    • The International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) has a website for searching for clinical trials:  www.ifpma.org/clinicaltrials.html
  • Treatment with dietary and lifestyle adjustments.
    • Purpose.  The purpose of dietary and lifestyle modification therapies is to reduce all symptoms by reducing conditions that may initiate or exacerbate (worsen) symptoms.
    • Sodium (salt) avoidance.
      • Physicians frequently prescribe a low-salt diet to reduce the amount of sodium in the body.  
        • Sodium in the body increases fluid retention.  Common table salt is, of course, sodium chloride, and is normally the primary source of sodium in the body.  On the theory that Meniere's Disease symptoms may result from excess endolymphatic fluid in the inner ear, physicians often counsel patients to reduce overall fluid in the body, with the hope that endolymphatic fluid will be reduced in the process.  To reduce sodium intake and, therefore, reduce bodily fluids, physicians often counsel a low-salt diet and, in addition, prescribe diuretics to further reduce the bodily fluids. 
      • Results vary.
        • Some patients anecdotally report a strong correlation between salt ingestion and onset or worsening of symptoms. Other patients anecdotally report no correlation between salt and symptoms at all.
      • What's a low-sodium (low-salt diet)?
        • Descriptions vary. Some say the less the better. Some degree of sodium intake is necessary to stay healthy. Many patients attempt to keep their sodium intake under 1,000 mg. per day. A few say that they succeed.  Ask your doctor how much sodium is right for you.
      • Low sodium websites.
        • LivingLowSodium.com.  One of the proprietors has Meniere's Disease (as stated here).  Books, snacks, soups, sauces, salad dressings, and more.  Friendly, artistic site design.
        • Saltwatcher.com.  Online resource with low-sodium information and recipes; also has food products for sale online.
        • Low Sodium Cooking Great site!  Quote:  "A can of chili may contain 2400 mg [of salt] all by itself; homemade chili may contain less than 100 mg."  Need we say more?
        • Salt Free Life. Terrific low-cost membership website! You don't have to do low salt to love the recipes, reviews, and cooking tips. Non-members get a free recipe every month. Members may access an archive of over 240 recipes with new recipes posted every month. Now your family will love and share the low- and no-salt meals that you have to have. You can have dinner guests again without guilt! (No, we do NOT get paid to say this!)
        • Dr. Salt's Salt Page (Washington University). Alec Salt, Ph.D., is the author of this page on, ironically, salt; it is addressed specifically to Meniere's Disease patients.
      • Low sodium books.
    • Alcohol avoidance.
      • Some patients report that alcohol intake is devastating. Others report no effects whatsoever on their Meniere's Disease symptoms after imbibing.
    • Caffeine avoidance.
      • Many patients report that caffeine intake is devastating. Some patients report that caffeine has no effect whatsoever on their Meniere's Disease symptoms.
    • Nicotine avoidance.
      • Physicians nearly always prescribe cessation of smoking, and many Meniere's Disease patients -- who can -- quit out of necessity.
    • Stress avoidance.
      • Stress is suspected to have a role in Meniere's Disease, although stress is not well suited for objective measurement and is not well documented.
  • Treatment by identifying and avoiding triggers of symptoms
    • While the cause of Meniere's Disease is unknown, there are "triggers" that can (for known or unknown reasons) initiate or exacerbate (worsen) symptoms in *some* patients.  Most patients find it helpful to identify and avoid -- or treat -- triggers, when possible, thereby indirectly treating the symptoms of Meniere's Disease.
    • Triggers are highly individualized.  No one trigger affects all patients.  One might have a trigger that no one else has, and one might not have a trigger that many other patients have.  Statistics aren't useful here.  It's not a matter of "how likely" it is for one to have a particular trigger or how many (if any) other patients have a particular trigger.  Either one has the trigger or one doesn't.
    • If "it" triggers your symptoms, "it" triggers your symptoms, no matter what "it" is, and regardless of whether "it" triggers symptoms for anyone else.
    • Triggers known to affect many (but not all) patients.
      • Allergies, including food allergies.
        • Allergies, including food allergies, are believed by many researchers to have a role in triggering Meniere's Disease symptoms in *some* patients.  Identification and treatment of allergies may or may not help reduce Meniere's symptoms or frequency of occurrences, depending upon the patient.
        • Some patients seek allergy testing in order to see whether avoidance of allergenic reactions may help to reduce the frequency and/or intensity of Meniere's Disease episodes.  Anecdotally, this strategy seems to help some patients, but not all patients.
        • Dr. Jennifer Derebery, House Ear Institute, Los Angeles, studies the relationship of allergies to Meniere's Disease.
        • Click here to search PubMed for Meniere's Disease and allergy research by Dr. Jennifer Derebery.
      • Menstruation.
        • Some women patients anecdotally report a worsening of Meniere's symptoms in conjunction with menstrual cycles.
        • Washington University.
          • Dr. Gwen Morse and Dr. John House have authored a paper describing evidence of a  relationship between the menstrual cycle and Meniere's Disease responses in some women.  "Results from this study provide evidence that a unique relationship does exist between the menstrual cycle and Meniere's disease responses for some women. Knowledge gained from this study is beneficial in identifying the importance of appropriate clinical assessment methods of menstruate women with Meniere's disease. Recommendations include further research with larger samples and testing of different symptom management strategies for women of different perimenstrual symptom patterns."
      • Pregnancy.
        • Some women patients anecdotally report that their symptoms worsened during pregnancy; others reported that their symptoms lessened during pregnancy
        • Some women patients anecdotally report that their symptoms of Meniere's Disease first appeared either during pregnancy or soon after delivery.  Most patients anecdotally report that their symptoms did not first appear during pregnancy or soon after delivery.
      • Visual stimuli.  
        • Some patients anecdotally report that certain visual events, especially parallel vertical lines, will trigger dizziness and other symptoms. Here are some examples:
        • Streets and highways lined with trees or telephone poles.
        • Supermarket aisles.
        • Some motion pictures.
      • Sound. 
        • Sound can induce dizziness in the Meniere's patient (as well as in patients with certain other disorders).  Sound-induced dizziness is sometimes call Tullio's Syndrome or Tullio's Phenomenon.
      • Barometric pressure.
        • Some patients anecdotally report that changes in barometric pressure can trigger symptoms.  Some patients so affected track weather patterns very closely in an attempt to anticipate increases in symptoms.
      • Physical exercise and exertion, including sexual intercourse. 
        • We know of no clinical research on the effect of physical exercise and exertion, including sexual intercourse, on the symptoms of Meniere's Disease.
        • Some patients anecdotally report that they experience attacks of Meniere's symptoms brought on by physical exercise, including attacks during sexual intercourse.  Other patients do not have this experience.
        • Some patients anecdotally credit a so-called "healthy lifestyle," including what they believe to be "eating right" and regular physical exercise, with improvements in their overall health and well-being, including reduced symptoms of Meniere's Disease.  Other patients see no improvements in their symptoms.
        • Click here to search PubMed for Meniere's Disease and physical exercise research.
      • Other triggers.
        • There are literally a million possible triggers, because each patient is different.  The patient's objective is to identify triggers for oneself.
  • Treatment with complementary and alternative medicine (CAM).
  • Herbs, vitamins, minerals, and other supplements.
    • Homeopathy.
      • Cautions.
      • Homeopathic dilutions.  See Wikipedia for details.
        • A typical homeopathic dilution is "6C" or "30C."
          • At "6C," a substance is diluted to one part in 10,000,000,000,000 parts (of water, alcohol, etc.).
          • At "30C," there is on average less than one molecule of substance in 10,000,000,000,000,000,000,000,000,000,0000 parts (or water, alcohol, etc.).
    • Chiropractic.
    • Osteopathy.
      • Cautions.
      • Symptomatic relief after treatment of temporomandibular disorder (TMD) and cervical spine disorders (CSD) in patients with Meniere's disease: a three-year follow-up.  Abstract at PubMedAccording to the abstract, results showed that a coordinated treatment of TMD and CSD in patients with Meniere's disease is an effective therapy for symptoms of this disease. The results suggested that Meniere's disease has a clear association with TMD and CSD and that these three ailments appeared to be caused by the same stress, nervousness, and muscular tension.
  • Treatment with devices.
    • Pressure pulse devices.    Pressure pulse devices, as the term suggests, deliver pulses of air pressure.  First, an opening (tympanostomy) is created in the eardrum and a tympanostomy tube is inserted to maintain the opening so that it doesn't heal over.  Pulses of air pressure are delivered through the tube into the middle ear.  The structure that separates the middle ear from the inner ear has two membranes, known as the oval window and the round window.  The theory is that the pulses of pressure are somehow conveyed by virtue of the two membranes to the inner ear, and that the endolymphatic fluid in the inner ear is somehow in turn affected in some positive way that provides relief from the symptoms of Meniere's Disease.  The exact mechanism of how this might work is not known.
      • Meniett device.
        • The Meniett device is a portable air pressure pulse generator originally developed by the Swedish company Pascal Medical AB and now marketed in the U.S. by Medtronic Xomed.
          • From the Meniett website here:  "Although the actual mechanisms are still not fully understood, one theory is that the action of the pressure pulses on the fluid system, combined with other physiologic reactions in the ear, forces the excess endolymphatic fluid back into the endolymphatic sac."
        • December 2006 -- A study published in the medical journal Archives of Otolaryngology -- Head and Neck Surgery, published by the American Medical Association, reports highly encouraging results in a two-year survey of patients using the Meniett Device.  (Arch Otolaryngol Head Neck Surg. 2006 Dec;132(12):1311-6.)
        • Click here to search PubMed for Meniere's Disease and Meniett device.
        • This study shows the Meniett Device and the Enttex P-100 device "beneficial," equally so.  The Enttex P-100 device was preferred for its greater convenience and its much lower cost compared to the Meniett device. 
      • Enttex P-100 device.
    • Tinnitus retraining therapy (TRT).
    • Deep Brain Stimulation (DBS) device to treat tinnitus. 
      • Article on a trial of the DBS device, Rocky Mountain News (Denver), December 5, 2005.
        • The DBS device has previously been used to calm tremors from Parkinson's disease and other brain-related disorders.
        • This patient's tinnitus was so severe that she once contemplated suicide.
        • This patient's doctor is neurosurgeon Bruce Koppel, M.D., of the Medical College of Wisconsin (MCW), at Froedtert Hospital.
      • Related information --
    • Electrical stimulation to treat tinnitus.
  • Treatment with vestibular rehabilitation therapy (VRT).
  • Treatment with drugs (medicine).
    • It is always prudent to thoroughly research the effects and drug interactions of any medication that you contemplate taking. Talk to your pharmacist and to your physician.
    • Overview.
    • Diuretics.
      • Diuretics are often prescribed to treat Meniere's Disease, often in conjunction with a low-salt diet (see above), apparently for the purpose of reducing body fluids in general and endolymph in particular.  This treatment presumes that the patient suffers from (idiopathic) endolymphatic hydrops (excess endolymphatic fluid).
      • For unknown reasons, a patient's Meniere's Disease symptoms may not be responsive to one diuretic drug yet may be very responsive to another diuretic drug.  Thus, one should discuss with one's doctor trying at least two different diuretics before concluding that "diuretics don't work for me."
      • Notes from the University of Kansas (KU) Medical Center; scroll down to "treatment."
      • Maxzide (sometimes spelled (perhaps incorrectly) Maxide); Dyazide (generic: triamterene/hydrochlorothiazide (HCTZ)).
      • Diamox (generic:  acetazolamide).
      • Neptazane (generic:  methazolamide).  Somewhat less commonly, Neptazane, which is often prescribed to treat glaucoma, is prescribed to treat Meniere's Disease.  Washington University (St. Louis) Physicians; Emedicine.com.
      • Isosorbide. 
        • An osmotic diuretic named "isosorbide" is used to treat Meniere's Disease in Japan, according to this study.  (Note:  There is an "isosorbide" (isosorbide dinitrate), a vasodilator, that is used to treat angina pectoris (chest pain due to heart disease) in the U.S.  The two are NOT the same.)  Studies of treatment of Meniere's Disease in Japan with isosorbide date back more than 20 years.  Whether there any reason to think that the osmotic diuretic isosorbide would be any more effective than the diuretics triamterene/HCTZ (Maxzide, Diazide) or acetazolamide (Diamox) that are commonly prescribed in the U.S. is hard to say.  Some people seem to do better on triamterene/HCTZ than acetazolomide, and vice versa.  Perhaps some people would do better on isosorbide and perhaps not.  Like all things Meniere's, nothing is certain.   
    • Antiviral drugs.
      • We are hearing anecdotal reports from patients who are (perhaps by their own demand) being treated with antiviral drugs such as acyclovir (Zovirax), famciclovir (Famvir), and valacyclovir (Valtrex) -- with mixed results.  This apparently responds to a few studies finding a tenuous (in our view) connection between the herpes simplex virus (HSV) and Meniere's Disease.  (Read more at the herpes simplex virus section of our Cause Page.)  No study in PubMed states for a fact that HSV is a cause of Meniere's Disease.  There are almost no studies to be found at PubMed on the subject of treating Meniere's Disease with acyclovir or other antiviral drugs and none that finds that an antiviral drug is effective in treating vertigo caused by Meniere's Disease (for example, this study by Dr. Derebery, et al., of the House Ear Clinic in Los Angeles).
      •  "Effectiveness of Acyclovir on Meniere's Syndrome III Observation of Clinical Symptoms in 301 cases," Mitsuo Shichinohe, M.D., Ph.D., The Sapporo Medical Journal, Vol. 68, No. 4-6, December, 1999.  
        • The full text of this paper is available in English at Dr. Shichinohe's website here in eight separate download files (one download file for each of eight pages) in .pdf format.
        • This study is not listed in PubMedThe Sapporo Medical Journal is published by Sapporo Medical University, Sapporo Japan.  The "III" in the title means that this is the third paper in a series of three authored by Dr. Shichinohe, none of which appears in PubMedThe other two papers are cited in footnotes 1 and 2 of this study.  As of January 8, 2007, Dr. Shichinohe is listed as author or co-author of five articles in PubMed (click here).
        • Results:  In this study, patients were each treated with 2,000 mg/day of acyclovir for an average period of two weeks. There were 250 patients who were ultimately evaluated.  In 82.5% of cases diagnosed as Meniere's Disease, 85% of cases diagnosed as Meniere's Syndrome (symptoms of Meniere's Disease but other basic diseases could not be completely excluded), and 89.1% of cases diagnosed as vestibular dysfunction, vertigo disappeared, and tinnitus and hearing were improved.  No side effects were observed.
        • Limitations: This study was not randomized, not double-blind, not blind, and not controlled.  As stated in the study, patients "knew" of the effectiveness of acyclovir and "wished" the treatment. We have not found any subsequent citations to this study in PubMed.  We have found no replication of this study. A randomized, double-blind, placebo-controlled clinical trial of the antiviral drug famciclovir (Famvir) for reduction of Meniere's disease symptoms by Dr. Derebery, et al., of the House Ear Clinic in Los Angeles, reported in 2004, found no "dramatic" effects on "vertigo or dizziness" and that famciclovir simply "may" suppress the fluctuation of hearing.
        • Comment:  Despite the limitations of Dr. Shichinohe's study, the results are impressive.  While a viral etiology (cause) of Meniere's Disease has not been positively established, there are researchers who suspect, even in the absence of persuasive evidence, that a virus, and particularly the herpes simplex virus (HSV), *may* be a factor in *some* cases diagnosed as Meniere's Disease.  We believe that it can be worthwhile for patients to discuss this study with their doctors, together with other relevant studies. 
      • Click here to search PubMed for Meniere's Disease and (herpes or (acyclovir and other antiviral drugs)).
      • Click here to search PubMed for Meniere's Disease and acyclovir and other antiviral drugs.
      • Click here to search PubMed for Meniere's Disease and herpes.
    • Vestibular sedatives.
      • These drugs are intended to sedate the vestibular system to reduces the effects of vertigo (the spinning sensation).  Not surprisingly, these "vestibular sedatives" can have a side effect of drowsiness.  Yet, some patients complain that the vestibular sedatives make them drowsy.  Such is the nature of medicine:  one trades off the benefit of the treatment in exchange for acceptance of the side effects.  In this case, one makes a choice as to whether one would prefer vertigo or drowsiness.  However, what many patients fail to understand is that they can work with their doctors to adjust the dosage of the vestibular sedatives to reach the point at which the patient is willing to accept the trade-off:  the point at which the vertigo is sufficiently controlled and at which the patient is willing to accept that particular degree of drowsiness as a side effect.  One's doctor may either adjust the strength of the prescription or simply advise the patient to break or cut the pills.
      • Valium (diazepam).
        • The purpose of Valium in treating Meniere's Disease is to prevent or reduce vertigo by sedating the vestibular system.
      • Antivert, Meclizine (meclizine hydrochloride). 
        • Antivert (Meclizine) is the antihistamine meclizine hydrochloride, which is also a vestibular sedative, purpose of which  in the treatment of  Meniere's Disease is to prevent or reduce vertigo and hence the resultant nausea by sedating the vestibular system.  
        • Information on meclizine hydrochloride is available at MedLinePlus (NIH).
        • Meclizine hydrochloride 25 mg. tablets may be purchased over-the-counter in the U.S. and elsewhere under various brand name and private label products sold for car, air, and seasickness, including Dramamine II and Dramamine Less Drowsy Formula (but not regular Dramamine), Bonamine, and BonineNames and formulations vary and are subject to change; be sure to read the ingredients and potency listed on the package.
        • Also available in generic form, over the counter (but sometimes "behind the counter," meaning one asks the pharmacist for it but a prescription is not required).
        • Generic meclizine hydrochloride can be bought by mail without prescription at Amazon.com and elsewhere.
      • Dramamine (but not Dramamine II or Dramamine Less Drowsy Formula), Gravol (Canada) (dimenhydrinate). 
        • Dramamine (but not Dramamine II or Dramamine Less Drowsy Formula) and Gravol (Canada) are brand names for the antihistamine dimenhydrinate, which is also a vestibular sedative, the purpose of which in the treatment of  Meniere's Disease is to prevent or reduce vertigo and hence the resultant nausea by sedating the vestibular system.  Names and formulations vary and are subject to change; be sure to read the ingredients and potency listed on the package.
      • Phenergan (promethazine hydrochloride).  
        • Phenergan is a brand name for the antihistamine promethazine hydrochloride, which is also a vestibular sedative, the purpose of which in the treatment of  Meniere's Disease is to prevent or reduce vertigo and hence the resultant nausea by sedating the vestibular system.  Those who are currently experiencing nausea and vomiting and are unable to "keep down" the oral form may well find that rectal suppositories of this drug are much more effective.
        •   May be prepared in a topical (tube) form for application to the skin (for absorption through the skin) by a pharmacy if so ordered by a prescription, but not all doctors and pharmacists are aware of this.
      • Stugeron (cinnarizine) (not available in the U.S.). 
        • Stugeron is a brand name for the antihistamine cinnarizine, which is also a vestibular sedative, the purpose of which in the treatment of  Meniere's Disease is to prevent or reduce vertigo and hence the resultant nausea by sedating the vestibular system.  Stugeron is commonly prescribed in the U.K., but is not available in the U.S.
        • Manufacturer's information.
        • Click here to search PubMed for Meniere's Disease and cinnarizine.
      • Compazine, stemzine, buccastem, stemetil, phenotil (prochlorperazine). 
        • Compazine, stemzine, buccastem, stemetil, phenotil are brand names for the anti-psychotic drug prochlorperazine, which also has antivertiginous and antiemetic properties, the purpose of which in the treatment of  Meniere's Disease is to control vertigo and resultant nausea.
    • Anti-nausea drugs.
      • Unlike some diseases and conditions, and some drugs, Meniere's Disease does not cause nausea.  Meniere's Disease causes vertigo (the spinning sensation), a consequence of which may be nausea.  A consequence of the nausea may be vomiting -- sometimes severe, even projectile, vomiting.  Ideally, one would control one's nausea by controlling one's vertigo.  However, when attempts at controlling one's vertigo are ineffective, then one will still want to try to control the consequential nausea.  One of the problems with taking medicine to control nausea is that if one is already vomiting, one will have difficulty in keeping down and absorbing oral meds.
      • Scopolamine transdermal patch.
        • This patch was off the U.S. market for some time, but it's back. Scopolamine is sometimes prescribed as an antiemetic, antinausea drug to treat the nausea of Meniere's Disease brought on by vertigo.
      • Phenergan (promethazine hydrochloride).
        • An antihistamine and vestibular sedative, the purpose of which in treating Meniere's Disease is to sedate the vestibular system. Those who are currently experiencing nausea and vomiting and are unable to "keep down" the oral form may well find that rectal suppositories of this drug are much more effective.
      • Ginger root.
        • Although ginger root is not a "drug," we mention it here because so many people find that ginger root, or ginger root tea, is effective in reducing nausea.
    • Immunosuppressant (immuno-suppressant) drugs. 
      • Immunosuppressant drugs include:  prednisone, methotrexate, dexamethasone, Enbrel, Remicade, etc.
      •  
        (Note that dexamethasone may also be delivered intratympanically; see below.)
      • Treatment of immune-mediated (induced) conditions.  (Also called immune-mediated, autoimmune-mediated, and auto-immune-mediated conditions.) 
      • Prednisone.
        • Prednisone is a generic name for several branded drugs; it is a steroid, the purpose of which in treating Meniere's Disease is to suppress the immune system and/or to reduce inner ear inflammation.  You should be extremely careful in following the prescribed instructions for taking this powerful drug, especially any instructions regarding a tapered withdrawal. Prednisone is often prescribed for Meniere's Disease, sometimes in combination with, or preceding, treatment with methotrextate (MTX) or other powerful immunosuppressant drugs.  Chronic (long-term) administration of prednisone would have extremely serious side effects that should be discussed with your doctor.
        • A doctor who suspects or just wants to confirm or eliminate the possibility of an immune-mediated etiology (cause) may prescribe a round of prednisone, even in the absence of diagnostic tests that indicate an autoimmune etiology. Some patients may not be responsive to a low-dose trial of prednisone yet may inexplicably respond remarkably to a high-dose trial of prednisone.  If the patient's symptoms are reduced by the prednisone, then longer-term immunosuppressant treatment may be recommended.
        • MedicineNet on prednisone.
        • Coping With Prednisone (and Other Cortisone-Related Medicines); It May Work Miracles, but How Do You Handle the Side Effects? by Eugenia Zukerman and Julie R. Ingelfinger, M.D.
      • Methotrexate (MTX).
        • This immunosuppressant drug has been used to treat suspected immune-mediated cochleovestibular disorders. Note that methotrexate should be administered carefully and is reported to have caused deaths. See the article at RXMEDStill, methotrexate is widely prescribed for autoimmune diseases, especially rheumatoid arthritis.  Sometimes otologists will prescribe a therapy of methotrexate to be administered by a rheumatologist who has more experience with immunosuppressant drugs.
      • Emerging immunosuppressant drugs.
        • There are emerging immunosuppressant drugs, such as Enbrel and Remicade, that are finding their way into treatment of suspected immune-mediated Meniere's Disease.  Talk to your doctor.
    • Serc (betahistine hydrochloride or betahistine dihydrochloride). 
    • Histamine.
    • Lidocaine hydrochloride (Xylocaine).  
  • Treatment with surgery.
    • Overview.
    • Surgical talk.
      • According to this "erratum" note in a medical journal, many patients who are scheduled for surgery experience remission before the surgery is actually performed.   The authors suggest scheduling surgery two months in advance, possibly not in earnest, to see whether simply scheduling the surgery will produce remission.
    • Tubes.
      • Pressure equalization (PE) tubes, tympanostomy tubes, myringotomy tubes, ventilation tubes, and grommets.
      • The middle ear is "ventilated" by virtue of a structure called the Eustachian tube. This tube connects the middle ear to the pharynx (throat). It is like a valve that opens and closes. When it opens, air pressure in the middle ear is equalized with the outside air pressure. The Eustacian tube typically opens during yawning and swallowing.  The the function of the Eustacian tube, and the state of air pressure in the middle ear, can be tested by means of a tympanogram.
      • If the Eustachian tube is becomes dysfunctional by blockage due to congestion, infection or otherwise, air pressure in the middle ear can occur to the point of pain.  Congestion and infection may be treated by decongestants, antihistamines, and antibiotics (if the infection is suspected to be bacterial in nature).
      • For chronic (continuing) cases, doctors sometimes create an alternate opening to middle ear from the outer ear by creating an opening in the eardrum and by inserting a tube called a "pressure equalization (PE) tube" or a "ventilation tube" or, sometimes (especially in Australia), a "grommet." ("Pressure equalization" means "air pressure equalization.")  When a PE tube is in place, there is a continuous opening in the eardrum, and air pressure in the middle ear is continuously "equalized" with the air pressure outside of the middle ear. Infants suffering from middle ear infections (otitis media) often have PE tubes inserted.
      • The symptom of fullness that is experienced with Meniere's Disease feels just like air pressure in the middle ear -- but it is *not* air pressure in the middle ear. Meniere's Disease does not affect the middle ear.  Meniere's Disease has nothing to do with the Eustachian tube, and the typical Meniere's Disease patient has a fully functioning Eustachian tube. If so, adding a PE tube wouldn't seem to accomplish anything. Nonetheless, doctors sometimes insert PE tubes into patients who have fully functional Eustachian tubes, and the patients sometimes report improvement with their symptoms, possibly (or probably) due to a placebo effect.
      • Click here to read Dr. Timothy Hain's comments on PE tubes.
      • Click here to search PubMed for Meniere's Disease and pressure equalization (PE) tubes (also called ventilation tubes and grommets).
    • Intratympanic instillation and perfusion of drugs.
      • Also called transtympanic instillation and perfusion of drugs.
      • Intratympanic (through the tympanic membrane (ear drum)) instillation (insertion) and perfusion ("seeping" through the round window separating the middle ear from the inner ear) of various drugs, including dexamethasone (Decadron), streptomycin, and gentamicin).
      • Note:  The October 2004 issue (Vol. 27, pp. 955-1113) of "Otolaryngologic Clinics of North America" is devoted to "Intratympanics (sic) Treatment of Inner Ear Disease."  The titles of the 10 substantive articles inside appear relevant and interesting to Meniere's Disease patients.  Click here to view the contents.  Viewing the full text is trickier. There is a 30 day trial, there is access to individual articles, and there is access to purchasing a full issue. A more practical means of access is to visit a hospital or medical school library.  (See our research page.)
      • Drugs used in intratympanic instillation and perfusion.
      •  
        • Nonototoxic drugs. 
          • Corticosteroids.  Some corticosteroid drugs are used, perhaps among other purposes, to (1) reduce inflammation and (2) to suppress the immune system.
            • Dexamethasone (Decadron) (DMZ)).
              • The apparent purpose of intratympanic instillation and perfusion of the corticosteroid dexamethasone is to reduce inflammation and to suppress the immune system very directly, perhaps together with or followed by additional dexamethasone administered intravenously and/or orally. Apparently, this therapy presumes that inflammation and/or an autoimmune (overactive immune) condition is causing or contributing to the symptoms. Dexamethasone is apparently not believed to be ototoxic. Some physicians believe that this procedure has great potential for relieving vertigo while preserving, and in some cases, even improving hearing. Others disagree. As always, see your physician for medical advice.
              • Click here to search PubMed for Meniere's Disease and Dexamethasone (DMZ) (decadron).
              • August 10, 2005 -- A study on the use of intratrympanic dexamethasone (DMZ) to treat Meniere's Disease has been added to PubMed:  Dexamethasone inner ear perfusion by intratympanic injection in unilateral Meniere's disease: a two-year prospective, placebo-controlled, double-blind, randomized trialThe abstract names the affiliation of the authors as "National Institute of Neurology and Neurosurgery," which we presume refers to the institute by that name that is located in Mexico City. According to the abstract, in the experimental group of 11 patients who received injections of dexamethasone, nine patients achieved "complete control of vertigo," and the remaining two patients achieved "substantial control of vertigo" over two years. In the control group of 11 patients who received injections of a saline solution placebo, four of the patients achieved "complete control of vertigo," none achieved "substantial control of vertigo," three patients achieved lesser control of vertigo, and four patients were classified as treatment failures and went on to receive other treatment before the end of the two-year period.  Patients in the experimental group reported subjective improvements in the symptoms of tinnitus, aural fullness, and hearing loss, to a greater extent than did patients in the control group.
          • Labyrinth anesthesia (lidocaine).
            • From time to time, researchers will instill lidocaine (sometimes together with the drug Kinetin) into the middle ear (for subsequent perfusion into the inner ear) in hopes of improving Meniere's Disease symptoms.  Just how this might work has not been satisfactorily explained (at least, not to us).  Note that this is a topic distinct from the use of lidocaine in treating tinnitus (from Meniere's Disease or otherwise), above.
        • Ototoxic drugs ("ear poisons").
        •  
          • The purpose of intratympanic instillation and perfusion of ototoxic drugs ("ear poisons") is to chemically ablate (destroy) part or all of the inner ear.
            • Streptomycin ("strep").
              • The famous antibiotic streptomycin is very ototoxic, which is one reason why it is no longer used as an antibiotic, except in rare cases when there is no other treatment. Not only is streptomycin toxic to the vestibule (balance function), but it is also toxic to the cochlea (hearing function). Streptomycin may be used to chemically ablate the balance function, but it will also destroy whatever may be left of the hearing function, thus resulting in a "chemical labyrinthectomy" (in effect, destruction of the entire labyrinth).  An alternative would be a "surgical" labyrinthectomy, in which the organs of the labyrinth are surgically removed. A high dose of gentamicin (see below) could be used instead of streptomycin. Streptomycin may be administered intravenously to accomplish the same result, but the destruction that results from this procedure applies to both ears instead of one ear.  This methodology is usually used, if at all, only when the patient is bilateral (Meniere's Disease symptoms in both ears) and has already lost all, or nearly all, hearing in both ears.
              • Click here to search PubMed for Meniere's Disease and streptomycin.
            • Gentamicin ("gent").
              • Like streptomycin (above), gentamicin is an antibiotic, and it is also ototoxic, although less ototoxic than streptomycin.
              • There are three possible reasons for intratympanic instillation of gentamicin.
                • 1. To destroy the "dark cells" that produce endolymph, with the objective of reducing the production of endolymph, thus reducing the "hydrops." If this is the reason, the hope is that the tiny hairs in the vestibule (which affect the balance function) and the tiny hairs in the cochlea (which affect the hearing function) will be undamaged, or at least not damaged very much. This is usually a very low dose (in terms of volume and strength) of gentamicin. There may be one or more injections, and the length of time (interval) between multiple injections may vary.
                • 2. To damage the tiny hairs in the vestibule with the objective of impairing the transmission of faulty vestibular (balance) data to the brain. If this is the reason, the hope is that the tiny hairs in the cochlea will be undamaged, or at least not damaged much, because damage to the tiny hairs in the cochlea causes hearing loss. There may be one or more injections, and the length of time between multiple injections may vary. This is usually a somewhat higher dose of gentamicin that is given for purpose 1 above, but still a low enough dose to attempt to preserve whatever hearing may remain.
                • 3. To ablate (destroy) the labyrinth totally, using a high dose of gentamicin, with the objective of totally destroying the tiny hairs in the vestibule to block all transmission of vestibular (balance) data to the brain, and accepting the concurrent destruction of the tiny hairs in the cochlea, which will cause deafness. This high dose of gentamicin is usually (but not always) performed when there is little or no functional hearing left. This is called a "chemical labyrinthectomy," because the effect is to totally destroy all functions of the labyrinth, both vestibular and cochlear. Streptomycin (see above) could be used for this purpose instead of gentamicin.  An alternative would be a "surgical" labyrinthectomy, in which the organs of the labyrinth are surgically removed.
              • There are different "protocols" for each of the  methodologies above, depending on the patient and on the doctor. The strength of the gentamicin and the interval between the instillations may vary.
              • University of Pittsburgh Medical Center.
              • Click here to search PubMed for Meniere's Disease and gentamicin/gentamycin.
              • August 25, 2005 -- A study on the use of intratympanic gentamicin to treat Meniere's Disease has been added to PubMed:  Long-term results of the transtympanic (intratympanic) gentamicin treatment in Meniere's diseaseThe affiliation of the authors is the Clinic of Otolaryngology in Warsaw, and the article is in Polish.  According to the abstract, nine patients were followed for 24 months, of whom all nine achieved complete control of vertigo, while hearing was improved in six patients, unchanged in two patients, and profoundly lost in "only" one patient.
                • Comment:  We believe that "only" one out of nine patients deafened represents a serious risk.  It seems to us that key to the outcome of intratympanic gentamicin treatment is the protocol used:  the strength of the gentamicin, the quantity instilled, and the interval between instillations.  We believe that a good analysis of such studies can only be made having the specific protocols at hand. We recommend that a patient considering intratympanic gentamicin treatment ask one's doctor for the protocol contemplated and for the studies using that protocol upon which that doctor is relying in selecting it.  (Then sit back in your chair and watch the reaction.)
      • Methodology.
        • Simple injection.
          • In the simplest of methods, an office procedure, one lies on one's side, with the ear to be treated toward the sky and the other ear against the bed or whatever surface one is lying upon.  A surgeon swabs the ear drum with a local anesthetic, then pokes a needle through the ear drum and instills (injects with a syringe) a drug toward the round window.  [Note:  the source of this methodology is anecdotal reports from patients.]  The patient lies still for some period of time, and with luck the drug will pool in the round window and perfuse through the round window to the inner ear.  The procedure may be repeated every week or every few weeks for a few administrations.
        • Laser.
          • With this method, performed in an office, surgical suite, or hospital, one lies on one's side, with the ear to be treated toward the sky and the other ear against the bed or whatever surface one is lying upon.  The patient is either placed under general anesthesia or the ear drum is swabbed with a local anesthesia.  The surgeon then uses a laser to burn a hole through the ear drum.  (Note that the laser is not used to "treat" Meniere's Disease; the laser is merely a tool to place a hole in the eardrum.)  A drug is then instilled (injected with a syringe) toward the round window.  The patient lies still for some period of time, and with luck the drug will pool in the round window and perfuse through the round window to the inner ear.  The patient lies for a couple of hours or so in a recovery room in the position described above.  The hole in the eardrum heals over a couple of weeks.  This method might involve daily administration of the drug for a few days.
        • Gelfoam (absorbable gelatin sponge).
        •  
        • Silverstein MicroWick
        • .
    • Endolymphatic sac surgery.
    • Surgical labyrinthectomy (laby).
      • Surgical removal of the labyrinth (balance and hearing organs of the inner ear) of one ear. Usually performed only on patients who are already deaf in the affected ear, because this procedure removes both the balance and hearing mechanism in the ear. The remaining unaffected ear "learns" to provide all balance functions.
      • Click here to search PubMed for Meniere's Disease and labyrinthectomy.
    • Vestibular nerve section (VNS) or vestibular neurectomy (VN).
      • Although the VNS is described by some patients (and doctors) as the "gold standard" for treating the symptom of vertigo in Meniere's Disease patients, VNS is not 100% successful, for a variety of reasons. The nerve at issue is the vestibulocochlear (8th cranial) nerve. This nerve can be thought of as a road with a fork at each end. At the inner ear end, hearing nerve fibers coming from the cochlea form one branch of the fork, and balance nerve fibers coming from the vestibule form another branch of the fork. They join in what becomes the vestibulocochlear nerve that runs from the inner ear to the brain. Before the nerve reaches the brain, however, the nerve branches off into the vestibular branch and the auditory branch. Each branch attaches to the brain at a different site.  In VNS surgery, the surgeon severs (sections) the vestibular branch, thus interrupting the vertigo signals from the vestibule before they can reach the brain and cause dizziness. An attempt is made to leave the auditory branch untouched, therefore preserving whatever hearing remains at that point in time.  Of course, since VNS is merely a treatment for the symptom of vertigo, and since Meniere's Disease is incurable and progressive, hearing loss, tinnitus, and fullness continue to progress in every case.
      • Potential problems with VNS.
        • Human anatomy varies quite a bit from person to person, as is learned by medical students in their human anatomy and cadaver dissection classes.
        • In some patients, *some* vestibular fibers run with the auditory branch. Thus, they remain in service even after the vestibular branch is severed.
        • It is possible that the vestibular branch does not get completely severed.
        • It is possible that one has or develops Meniere's Disease in the other ear.
        • Occasionally, surgeons theorize that after surgery the severed ends of the vestibular branch have regenerated and "rejoined" or "reconnected," although we are greatly skeptical of this explanation.
        • There there is the unknown "aw shucks" factor. Sometimes, it just doesn't work out as expected and no one really knows why for sure.
        • Then there are other risks with VNS surgery.
          • The surgeon cuts the wrong nerve (it happens).  Sometimes the facial (7th cranial) nerve is mistaken for the vestibular branch of the vestibulocochlear (8th cranial) nerve.  This is a devastating problem.
          • The facial nerve is bruised during surgery (it runs close to the vestibulocochlear nerve).
          • A cerebral-spinal fluid (CSF) leak develops.
          • Infection is always a risk with surgery and with hospitalization.
          • Complications from anesthesia.
          • Remaining hearing is compromised, despite the theoretical preservation of remaining hearing (subject to the unrelenting progression of Meniere's Disease).
        • Failure of vestibular nerve section. 
      • VNS surgical techniques.   
        • There are several different techniques for locating and severing the vestibular nerve. Each technique has its advantages and disadvantages.  Talk to your doctor.
        • Some techniques sever the vestibular branch of the vestibulocochlear nerve near where it connects to the brain.  This is VERY invasive "intracranial" skull base surgery -- in other words, "brain surgery."  An alternative is to sever the vestibular branch near the inner ear.  All techniques are very, very serious surgery.  Talk to your doctor.
        • Here are some of the possible techniques:
      • Click here to search PubMed for Meniere's Disease and vestibular neurectomy (VN)/vestibular nerve section (VNS).
    • Microvascular Decompression (MVD).
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