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

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Ménière’s disease is a complex disorder that can significantly alter a person’s quality of life. While neither the exact cause nor pathophysiology underlying Ménière’s disease is well understood, several solid theories are being investigated and contribute to the current understanding of treatment options. Primary care clinicians can help determine this clinical diagnosis based on a detailed history and comprehensive assessment of recurrent vertigo with tinnitus, hearing loss, and possibly a sensation of aural fullness. Establishing the diagnosis of Ménière’s disease requires ruling out other possible causes of vertigo.

Lifestyle changes that improve the consistency of dietary intake of sodium, caffeine, and alcohol as well as reduction of stress are ongoing recommendations for patients with Ménière’s disease. Oral medications from a range of drug categories may be used to improve acute and chronic symptoms, including antiemetics, anticholinergics, antihistamines, benzodiazepines, and mild diuretics. Additionally, a compounded substance with vasodilator and histamine- receptor–antagonist properties (betahistine) can be used for treatment of Meniere’s.

Patients who do not respond well to conservative therapy should be referred to an otolaryngologist for possible intratympanic medications, ventilation tube placement with a prescription for pulse pressure therapy (ie, Meniett device), or surgical intervention. Primary care clinicians can initiate treatment for Ménière’s disease by recommending lifestyle changes, prescribing oral medications, providing patient education, and recognizing indications for referral.

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