LIVING WITH MENIERE’S DISEASE: HOW TO MANAGE THIS CHALLENGING BALANCE AND HEARING DISORDER
Abstract
Meniere’s disease is a chronic inner ear disorder characterized by recurrent vertigo, fluctuating hearing loss, tinnitus, and aural fullness. Despite extensive research, its aetiology remains unclear, complicating treatment. This review summarizes current therapeutic strategies for Meniere’s disease, spanning non-pharmacological, pharmacological, intratympanic, and surgical interventions. Lifestyle modifications, such as salt restriction and increased water intake, offer initial symptom control, though evidence remains limited. Pharmacological therapies, including diuretics, betahistine, and piracetam, provide varying degrees of vertigo relief, with inconsistent outcomes for hearing and tinnitus. Intratympanic treatments—steroids and gentamicin—are effective for refractory cases; steroids offer hearing preservation, while gentamicin achieves superior vertigo control at the risk of ototoxicity. Surgical options, including endolymphatic sac shunt surgery, semicircular canal plugging, vestibular neurectomy, and labyrinthectomy, are reserved for intractable cases, with selection guided by disease severity and hearing status. Emerging therapies, such as vestibular rehabilitation and Coriolus versicolor supplementation, show potential in improving vestibular compensation and reducing oxidative stress and inflammation. While current treatments primarily aim to manage symptoms rather than resolving the underlying disorder, ongoing research may lead to more targeted and disease-modifying therapies.
References
Adrion, C., Fischer, C. S., Wagner, J., Gürkov, R., Mansmann, U., & Strupp, M. (2016). Efficacy and safety of betahistine treatment in patients with Meniere’s disease: Primary results of a long term, multicentre, double blind, randomised, placebo controlled, dose defining trial (BEMED trial). The BMJ, 352. https://doi.org/10.1136/bmj.h6816
Albu, S., Babighian, G., Amadori, M., & Trabalzini, F. (2015). Endolymphatic sac surgery versus tenotomy of the stapedius and tensor tympani muscles in the management of patients with unilateral definite Meniere’s disease. European Archives of Oto-Rhino-Laryngology, 272(12), 3645–3650. https://doi.org/10.1007/S00405-014-3428-1
Attrache, N. A. Al, Krstulovic, C., Guillen, V. P., Pérez, C. M., & Garrigues, H. P. (2016). Response over time of vertigo spells to intratympanic dexamethasone treatment in meniere’s disease patients. Journal of International Advanced Otology, 12(1), 92–97. https://doi.org/10.5152/IAO.2016.2177
Ballard, D. P., Sukato, D. C., Timashpolsky, A., Babu, S. C., Rosenfeld, R. M., & Hanson, M. (2019). Quality-of-Life Outcomes following Surgical Treatment of Ménière’s Disease: A Systematic Review and Meta-analysis. Otolaryngology - Head and Neck Surgery (United States), 160(2), 232–238. https://doi.org/10.1177/0194599818803612
Bento, R. F., Cisneros, J. C., & De Oliveira Fonseca, A. C. (2017). Endolymphatic sac drainage for the treatment of Ménière’s disease. Journal of Laryngology and Otology, 131(2), 144–149. https://doi.org/10.1017/S0022215116009713
Burgess, A., & Kundu, S. (2009). Diuretics for Ménière’s disease or syndrome. In Cochrane Database of Systematic Reviews (Issue 4). https://doi.org/10.1002/14651858.CD003599.pub2
Cao, Z., Yue, F., Huang, W., Rajenderkumar, D., & Zhao, F. (2019). Different medications for the treatment of Ménière’s disease by intratympanic injection: A systematic review and network meta-analysis. Clinical Otolaryngology, 44(4), 619–627. https://doi.org/10.1111/coa.13350
Charpiot, A., Rohmer, D., & Gentine, A. (n.d.). Lateral Semicircular Canal Plugging in Severe Ménière’s Disease: A Clinical Prospective Study About 28 Patients.
Garduño-Anaya, M. A., De Toledo, H. C., Hinojosa-González, R., Pane-Pianese, C., & Ríos-Castañeda, L. C. (2005). Dexamethasone inner ear perfusion by intratympanic injection in unilateral Ménière’s disease: A two-year prospective, placebo-controlled, double-blind, randomized trial. Otolaryngology - Head and Neck Surgery, 133(2), 285–294. https://doi.org/10.1016/j.otohns.2005.05.010
Hansen, M. R., Gantz, B. J., & Dunn, C. (2013). Outcomes after cochlear implantation for patients with single-sided deafness, including those with recalcitrant méniére’s Disease. Otology and Neurotology, 34(9), 1681–1687. https://doi.org/10.1097/MAO.0000000000000102
Harris, J. P., & Alexander, T. H. (2010). Current-day prevalence of ménière’s syndrome. Audiology and Neurotology, 15(5), 318–322. https://doi.org/10.1159/000286213
Huang, C.-J., Wan, T.-K., Fang, T.-Y., & Wang, P.-C. (2019). CASP9 genotype confers gentamicin susceptibility in intratympanic treatment of intractable vertigo caused by Ménière’s disease. Acta Oto-Laryngologica, 139(4), 336–339. https://doi.org/10.1080/00016489.2019.1575525
Kim, M. H., & Cheon, C. (2020). Epidemiology and Seasonal Variation of Ménière’s Disease: Data from a Population-Based Study. Audiology and Neurotology, 25(4), 224–230. https://doi.org/10.1159/000506921
Lee, S. Y., Kim, Y. S., Jeong, B., Carandang, M., Koo, J. W., Oh, S. H., & Lee, J. H. (2021). Intratympanic steroid versus gentamicin for treatment of refractory Meniere’s disease: A meta-analysis. American Journal of Otolaryngology - Head and Neck Medicine and Surgery, 42(6). https://doi.org/10.1016/j.amjoto.2021.103086
Li, C. S., & Lai, J. T. (2008). Evaluation of retrosigmoid vestibular neurectomy for intractable vertigo in Ménière’s disease: An interdisciplinary review. Acta Neurochirurgica, 150(7), 655–661. https://doi.org/10.1007/s00701-007-1462-0
Li, X., Lv, Y., Wang, R., Chao, X., Fan, Z., Wang, H., & Zhang, D. (2021). Intraoperative auditory brainstem response monitoring during semicircular canal plugging surgery in treatment of Meniere’s disease. Acta Oto-Laryngologica, 141(1), 73–77. https://doi.org/10.1080/00016489.2020.1823015
Liu, B., Leng, Y., Zhou, R., Liu, J., Liu, D., Zhang, S. L., & Kong, W. J. (2016). Intratympanic steroids injection is effective for the treatment of drop attacks with Ménière’s disease and delayed endolymphatic hydrops A retrospective study. Medicine (United States), 95(52). https://doi.org/10.1097/MD.0000000000005767
Liu, H., Zhang, T., Wu, Q., Zhang, Y., & Dai, C. (2017). End-point indicators of low-dose intra-tympanic gentamicin in management of Ménière’s disease. Acta Oto-Laryngologica, 137(2), 136–143. https://doi.org/10.1080/00016489.2016.1224921
Lopez-Escamez, J. A., Carey, J., Chung, W. H., Goebel, J. A., Magnusson, M., Mandalà, M., Newman-Toker, D. E., Strupp, M., Suzuki, M., Trabalzini, F., & Bisdorff, A. (2015). Diagnostic criteria for Menière’s disease. Journal of Vestibular Research: Equilibrium and Orientation, 25(1), 1–7. https://doi.org/10.3233/VES-150549
MacArthur, C., Hausman, F., Kempton, B., & Trune, D. R. (2015). Intratympanic Steroid Treatments May Improve Hearing via Ion Homeostasis Alterations and Not Immune Suppression. Otology and Neurotology, 36(6), 1089–1095. https://doi.org/10.1097/MAO.0000000000000725
Mcdonnell, M. N., & Hillier, S. L. (2015). Vestibular rehabilitation for unilateral peripheral vestibular dysfunction. In Cochrane Database of Systematic Reviews (Vol. 2015, Issue 1). John Wiley and Sons Ltd. https://doi.org/10.1002/14651858.CD005397.pub4
Molnár, A., Maihoub, S., Tamás, L., & Szirmai, Á. (2021). Conservative Treatment Possibilities of Ménière Disease, Involving Vertigo Diaries. Ear, Nose & Throat Journal, 100(7), 536–542. https://doi.org/10.1177/0145561319881838
Naganuma, H., Kawahara, K., Tokumasu, K., & Okamoto, M. (2006). Water may cure patients with Meniere disease. Laryngoscope, 116(8), 1455–1460. https://doi.org/10.1097/01.mlg.0000225904.78569.0c
Nauta, J. J. P. (2014). Meta-analysis of clinical studies with betahistine in Méniè re’s disease and vestibular vertigo. In European Archives of Oto-Rhino-Laryngology (Vol. 271, Issue 5, pp. 887–897). Springer Verlag. https://doi.org/10.1007/s00405-013-2596-8
Paola, R. Di, Siracusa, R., Fusco, R., Ontario, M., Cammilleri, G., Pantano, L., Scuto, M., Tomasello, M., Spanò, S., Salinaro, A. T., Abdelhameed, A. S., Ferrantelli, V., Arcidiacono, A., Fritsch, T., Lupo, G., Signorile, A., Maiolino, L., Cuzzocrea, S., & Calabrese, V. (2024). Redox Modulation of Meniere Disease by Coriolus versicolor Treatment, a Nutritional Mushroom Approach with Neuroprotective Potential. Current Neuropharmacology, 22(12), 2079–2098. https://doi.org/10.2174/1570159X22666231206153936
Patel, M., Agarwal, K., Arshad, Q., Hariri, M., Rea, P., Seemungal, B. M., Golding, J. F., Harcourt, J. P., & Bronstein, A. M. (2016). Intratympanic methylprednisolone versus gentamicin in patients with unilateral Ménière’s disease: a randomised, double-blind, comparative effectiveness trial. The Lancet, 388(10061), 2753–2762. https://doi.org/10.1016/S0140-6736(16)31461-1
Perez, N., Santandreu, E., Benitez, J., & Rey-Martinez, J. (2006). Improvement of postural control in patients with peripheral vestibulopathy. European Archives of Oto-Rhino-Laryngology, 263(5), 414–420. https://doi.org/10.1007/s00405-005-1027-x
Perkins, E., Rooth, M., Dillon, M., & Brown, K. (2018). Simultaneous labyrinthectomy and cochlear implantation in unilateral meniere’s disease. Laryngoscope Investigative Otolaryngology, 3(3), 225–230. https://doi.org/10.1002/lio2.163
Pullens, B., & van Benthem, P. P. (2011). Intratympanic gentamicin for Ménière’s disease or syndrome. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.cd008234.pub2
Roberts, D. S., & Slattery, W. H. (2016). Labyrinthectomy for Meniere’s Disease. Operative Techniques in Otolaryngology - Head and Neck Surgery, 27(4), 188–193. https://doi.org/10.1016/j.otot.2016.10.002
Sam, G., Chung, D. W., van der Hoeven, R., Verweij, S., & Becker, M. (2016). The effect of intratympanic gentamicin for treatment of Ménière’s disease on lower frequency hearing. International Journal of Clinical Pharmacy, 38(4), 780–783. https://doi.org/10.1007/S11096-016-0295-4
Sbeih, F., Christov, F., & Gluth, M. B. (2018). Newly Diagnosed Meniere’s Disease: Clinical Course With Initiation of Noninvasive Treatment Including an Accounting of Vestibular Migraine. Annals of Otology, Rhinology & Laryngology, 127(5), 331–337. https://doi.org/10.1177/0003489418763224
Shlamkovitch, N., Lasry, R., Ephraim, E., Marom, T., & Gavriel, H. (2018). Low Concentration Intra-Tympanic Gentamicin Treatment for Menière’s Disease: A Long-Term Follow Up. Otology & Neurotology, 39(7), 903–907. https://doi.org/10.1097/MAO.0000000000001882
Tong, Q., Zhou, Y., Wu, P., & Yu, H. (2025). Effect of vestibular rehabilitation treatment (VRT) on patients with unsteadiness after intratympanic gentamicin in Menière’s disease: protocol for a randomised controlled trial. BMJ Open, 15(2), e088722. https://doi.org/10.1136/BMJOPEN-2024-088722
van Deelen. (1986). Use of a Diuretic in the Treatment of Meniere’s Disease.
Véleine, Y., Brenet, E., Labrousse, M., Chays, A., Bazin, A., Kleiber, J. C., & Dubernard, X. (2022). Long-term efficacy of vestibular neurotomy in disabling Ménière’s disease and Tumarkin drop attacks. Journal of Neurosurgery, 137(4), 1034–1040. https://doi.org/10.3171/2021.10.JNS21145
Webster, K. E., Galbraith, K., Lee, A., Harrington-Benton, N. A., Judd, O., Kaski, D., Maarsingh, O. R., MacKeith, S., Ray, J., Van Vugt, V. A., & Burton, M. J. (2023). Intratympanic gentamicin for Ménière’s disease. In Cochrane Database of Systematic Reviews (Vol. 2023, Issue 2). John Wiley and Sons Ltd. https://doi.org/10.1002/14651858.CD015246.pub2
Wu, V., Sykes, E. A., Beyea, M. M., Simpson, M. T. W., & Beyea, J. A. (2019). Approach to Ménière disease management. Canadian Family Physician, 65(7), 463–467.
Xia, Y., Wang, D., Li, J., Chen, M., Wang, D., Jiang, Z., & Liu, B. (2022). Compounds purified from edible fungi fight against chronic inflammation through oxidative stress regulation. In Frontiers in Pharmacology (Vol. 13). Frontiers Media S.A. https://doi.org/10.3389/fphar.2022.974794
Yardley, L., Dibb Ã, Ã. B., OSBORNEy Ã, G., & D L E Y L, Y. R. (2003). Factors associated with quality of life in Menie Áre’s disease. In Clin. Otolaryngol (Vol. 28).
Yaz, F., Ziylan, F., Smeeing, D. P. J., & Thomeer, H. G. X. M. (2020). Intratympanic Treatment in Menière’s Disease, Efficacy of Aminoglycosides Versus Corticosteroids in Comparison Studies. Otology & Neurotology, 41(1), 1–10. https://doi.org/10.1097/MAO.0000000000002451
Zhang, D., Fan, Z., Han, Y., Lv, Y., Li, Y., & Wang, H. (2016). Triple semicircular canal plugging: a novel modality for the treatment of intractable Meniere’s disease. Acta Oto-Laryngologica, 136(12), 1230–1235. https://doi.org/10.1080/00016489.2016.1206966
Zhang, D., Lv, Y., Han, Y., Li, Y., Li, X., Wang, J., Song, Y., Kong, L., Jian, H., Fan, Z., & Wang, H. (2020). Long-term outcomes of triple semicircular canal plugging for the treatment of intractable Meniere’s disease: A single center experience of 361 cases. Journal of Vestibular Research, 29(6), 315–322. https://doi.org/10.3233/VES-190682
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