Meniere's Disease

W. Steven Pray, PhD, DPh

US Pharmacist. 2005;30(7)

Treatment

Meniere's cannot be cured. However, the pharmacist can help with useful tips and can explain the use of prescribed medications.

During an attack, the patient will need help in walking to a safe place to sit or lie down. Hearing aids may be necessary for any hearing loss that persists. Patients must be exhorted to rest quietly during attacks, rather than attempt to carry out normal activities of daily living. Reading, bright lights, video game playing, and television watching may worsen an ongoing episode.

One method of treatment is aimed at reducing pressure in the endolymphatic sac. Triamterene/hydrochlorothiazide may be taken between attacks to reduce the fluid accumulation.^[5] During an acute attack, meclizine 12.5 mg once daily up to 50 mg three times daily may be helpful. Physicians have also prescribed lorazepam, promethazine (oral or rectal), and dexamethasone.

When oral medications fail, physicians may attempt to solve debilitating Meniere's disease in a more direct manner. Surgery on the endolymphatic sac can provide relief while maintaining inner ear function.^[3] In another approach, gentamicin is instilled into the middle ear to take advantage of the well-known ototoxicity of aminoglycosides. However, the risk of vestibular and cochlear toxicity must be weighed against the possible relief to be obtained from the procedure.^[3]

1 2 3 4 5

Next Section

Cite this: Meniere's Disease - Medscape - Jul 15, 2005.

Sidebar: Meniere's Disease - Take Caution During an Attack

An attack of Meniere's disease cannot be accurately predicted or prevented. However, pharmacists can help explain the use of prescribed medications, such as diuretics or antihistamines, to help manage attacks and to treat symptoms.

You or someone you know may suffer from a condition known as Meniere's disease. The condition causes you to have a sudden attack of vertigo (dizziness), hearing loss, ringing in the ears, and a feeling of fullness in the ear, perhaps along with nausea and vomiting. The first attack is extremely frightening, and you may have visited an emergency department in an attempt to discover what was wrong.

When an attack is ongoing, you may be unable to walk without assistance, and the nausea/vomiting can appear rapidly. It is helpful to lie down on a firm, nonmoving surface (a waterbed would be a poor choice). You should try to lie as still as you can while the attack is proceeding. Keep your eyes open during the attack, and try to focus your vision on a nonmoving object, such as a lamp or light fixture that is not turned on (not a rotating ceiling fan). Eventually, the spinning sensation will pass, and you may feel more normal. Sit up slowly, and if the dizziness returns, lie back down until you can sit up comfortably.

The nausea may be so severe that you cannot eat or drink anything during the attack without vomiting. There is no nonprescription product for the vomiting due to Meniere's disease; therefore, you should visit your physician for specific prescription medications.

Your physician may prescribe an antihistamine, such as meclizine, to manage the attacks. Be aware that the medication will make you drowsy. Do not attempt to drive while taking it until you find out how drowsy the antihistamine will make you.

If your physician prescribes medication for Meniere's disease, you should take it as directed. Sometimes, a diuretic (water pill) can help reduce the amount of fluid in your inner ear, preventing attacks. Triamterene/hydrochlorothiazide in combination is a popular choice.

Your physician may also provide advice about a special diet that can prevent attacks. Generally, you should limit your amount of salt and sugar intake each day. Both can affect the balance of fluid and chemicals in your inner ear, possibly leading to an attack. The recommended daily amount of sodium is 1,000 mg. Any meal with excessively high salt intake can start an attack. You should eat meals that are equally divided in the number of calories, and drink plenty of fluids each day. Try to eat and drink the same amounts of food from day to day, and avoid skipping meals.

In addition, you should avoid caffeine of all forms (soft drinks, tea, coffee, and chocolate). Caffeine increases the tinnitus that comes with a Meniere's attack and can trigger an attack of migraine headache. Alcohol should be limited to one can of beer or glass of wine daily, as alcohol can also trigger migraine.

Cigarettes shrink blood vessels; this can reduce your inner ear's blood supply, worsening your symptoms. Aspirin can cause tinnitus and should be avoided unless you are taking it because of a physician's recommendation.

Comments

Commenting is limited to medical professionals. To comment please Log-in.

Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.