How is Meniere’s disease treated?

There are three main ways to treat Meniere’s disease:  treating the hydrops problem, reducing vascular risk factors, and if all else fails, shutting down the problem ear. 

The first step to take is to eliminate all of your vascular risk factors.  If you can’t control these, you will usually keep having spells, and you will be at risk for other serious diseases, like heart attacks and strokes. 

If you snore or wake up frequently during the night, a test for sleep apnea is important since this is one of the main risk factors for Meniere’s disease.  If you have sleep apnea, you will usually be given CPAP, a machine that increases the air pressure entering your nose or mouth.  This keeps your airways fully open while you sleep, preventing the low oxygen that sets off vasospasm. Another major risk factor is migraine.  Migraine headaches can cause vasospasm, so you may need to take daily medications that prevent migraines from forming: amitriptyline, verapamil, valproate, propranolol, topiramate and others.  These can be obtained from your neurologist or primary care.   Smoking causes vasospasm and damages the blood vessels, so stopping this can help reduce attacks.  Have your physician check you for high blood pressure, high cholesterol, and diabetes as each of these can increase the number of spells you suffer.  Autoimmune diseases, especially those that cause increased blood clotting, need to be controlled as well. 

It’s much harder to treat the hydrops problem.   A low sodium diet can reduce fluid buildup in the body, including in the inner ear, and also helps reduce blood pressure in people with the vascular risk factor, hypertension.  It’s one of the oldest  treatments for Meniere’s disease and can reduce the number of spells over time.  Another old and helpful treatment is to take a diuretic, or “water pill”.  These remove sodium and water from the body, including from the inner ear.  This is believed to reduce the hydrops, and these also treat hypertension.  The inner ear is deep in the skull behind the eardrum, and it is also very small, so it is hard to approach surgically.  For many years surgeons have tried small tubes called endolymphatic shunts to remove excess fluid, but these have a poor rate of success.   They also don’t address the problem of vascular risk. 

What if spells keep happening, even after you’ve tried everything?  The usual treatment then is to “unplug” (ablate) the ear.  The most common way to do this is gentamicin ablation, injecting a medication behind the eardrum that numbs up the hair cells that control balance.  Gentamicin is an old antibiotic that was noticed to cause loss of balance when used in high doses in the past.  When injected in one ear, it will reduce the ability to feel vertigo in the treated ear only, leaving the remaining ear to provide normal balance. It’s a simple procedure and highly effective.  Older methods but still helpful methods to control vertigo include cutting the balance nerve leading to the ear (vestibular neurectomy), or by surgically removing the entire inner ear from the skull (labyrinthectomy). The latter causes permanent hearing loss, so is used only in people who have already lost hearing in the treated ear.

Some people have Meniere’s disease in both ears, and this complicates the treatment.  The surgical methods to  ablate the ear can’t be used, because losing balance in both ears interferes with eye movement control, causing oscillopsia.  For bilateral disease, the key will be to use both vascular risk factor reduction and hydrops medications.  Sometimes, if one ear is severely affected and one is only mildly impaired, surgery can be used on the more severe ear, but this requires a very careful and experienced otologist.