Ménière’s Disease: A Lifelong Merry-Go-Round

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Lifestyle Changes
Dietary changes. Patients diagnosed with Ménière’s disease may benefit from following a low-sodium diet, limiting their daily sodium intake to between 1,000 and 2,000 mg.2,7,11 A low-sodium diet is believed to have a positive impact on inner ear fluid homeostasis by decreasing fluid retention and reducing the endolymphatic hydrops.2,7,11 Decreasing alcohol and caffeine consumption is also routinely recommended as part of the treatment of Ménière’s disease.2,5

Researchers have recently suggested a different approach to dietary changes for Ménière’s disease that reflects the underlying loss of ability to regulate fluid in the inner ear. This alternate method of dietary regulation aims to maintain fluid homeostasis by avoiding variations in the daily intake of sodium, caffeine, or alcohol, rather than limiting daily consumption.5

The goal of any proposed dietary changes is to limit fluid and electrolyte shifts that could disrupt the delicate fluid balance in the inner ear.9 When caring for patients with Ménière’s disease, clinicians need to keep in mind that dietary changes may be difficult and will probably require ongoing encouragement.

Stress reduction. Stress is associated with the occurrence of Ménière’s disease and often is the trigger for an acute episode of symptom exacerbation.5 Thus, clinicians should encourage stress management as a way to reduce the impact of Ménière’s disease on a patient’s life. Stress reduction techniques that can be recommended include progressive relaxation, meditation with deep breathing, yoga, and exercise.

Although studies of the effect of stress reduction methods on Ménière’s disease are not available in the current literature, the association of stress with Ménière’s disease is well documented.5 By avoiding stress, it is hoped, patients may experience a reduction in the frequency and severity of Ménière’s disease–associated episodes of vertigo. Researchers also suggest that stress reduction and patient education may help alleviate patients’ feelings of frustration resulting from misinformation about their condition.2,11

Oral Medications for Acute Relief
Acute attacks of vertigo associated with Ménière’s disease can be treated with benzodiazepines, antiemetics, or anticholinergic medications.4,6 Alleviation of symptoms is achieved through different physiologic pathways, based on the drug category prescribed. If a patient reports typical symptoms of Ménière’s disease but has not undergone audiometry, the plausible diagnosis may lead to tentative treatment for acute episodes if other causes of vertigo have been ruled out.

Antihistamines, such as meclizine or dimenhydrinate, may help reduce vertigo symptoms and associated nausea by blocking the effects of histamine.4,6 One of the most common side effects of antihistamines is drowsiness, so patients must be cautioned to avoid certain activities while taking this medication. Antihistamines should not be given to patients with glaucoma or prostate disease due to the potentially strong anticholinergic effects of these drugs.4,6

Scopolamineis a belladonna alkaloid that can be applied topically on the tissue just behind the ear to help reduce nausea and vomiting related to vertigo.11

Another option for treatment of acute vertigo is a benzodiazepine, such as alprazolam, to suppress active cerebellar responses; this agent may also reduce anxiety associated with an acute episode of vertigo.6,11 Benzodiazepines should be started at the lowest dose and increased as needed to the maximum recommended for individual medications based on symptom relief and side effects.6 Although caution needs to be used when prescribing benzodiazepines, studies show that they can be effective for persons with Meniere’s disease.11

Other antiemetic medications, such as promethazine or ondansetron, may be needed to treat severe nausea, but these agents should be used cautiously with other medications due a potential side effect of sedation.

Long-Term Oral Medication
Medication for long-term management of Ménière’s disease can promote improvement in symptoms and reduce the frequency of vertigo episodes. A mild diuretic, such as hydrochlorothiazide with or without triamterene, taken on a regular basis reduces extracellular fluids and may decrease pressure from endolymphatic hydrops.2,7 While strong evidence regarding the efficacy of diuretics is lacking, the majority of patients with Ménière’s disease who are treated with diuretics do experience improvement in vertigo.2,5

Betahistine hydrochloride, a vasodilator and histamine receptor antagonist, is another medication to consider for management of Ménière’s disease.1 This agent is not approved by the FDA; however, the FDA classifies betahistine as an inert chemical, so it is available in compounding pharmacies in the United States. The efficacy of betahistine has not been clearly or consistently established in research studies, but it has been and continues to be widely used to treat Ménière’s disease in Europe, with good results. Betahistine affects the microcirculation in the inner ear and inhibits the vestibular nuclei, which may reduce the frequency of vertigo episodes and improve tinnitus associated with Ménière’s disease.2,8,11

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