Treatment of Méniére's Disease When Dietary Modifications and Vestibular Suppressants Have Not Controlled Attacks

Clinical scenario

This protocol addresses patients with Méniére's disease whose first-line management — dietary and lifestyle changes combined with short-term vestibular suppressants used during attacks — has not achieved adequate control of the condition.

What the previous regimen did not achieve

The initial approach of dietary and lifestyle modifications (low-sodium diet, alcohol restriction, caffeine restriction) combined with a limited course of vestibular suppressants aimed to reduce or prevent the severity and frequency of vertigo attacks and to relieve or prevent hearing loss, tinnitus, and aural fullness. When those goals remain unmet, escalation to maintenance pharmacotherapy is indicated.

Next-step approach (partial summary)

The next line centres on oral maintenance pharmacotherapy — specifically, a diuretic and/or betahistine — intended to reduce symptoms on an ongoing basis and to prevent attacks. The complete selection of agents, sequencing, and management considerations are detailed in the full protocol.

Treatment goals

Reduction of symptoms and prevention or control of Méniére's disease vertigo attacks.

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References

DOI: 10.1177/0194599820909438

Clinicians may offer diuretics and/or betahistine for maintenance therapy to reduce symptoms or prevent Ménière's disease attacks.
The most commonly prescribed diuretics are thiazides with or without potassium-sparing diuretics such as hydrochlorothiazide/triamterene or spironolactone as well as the carbonic anhydrase inhibitor acetazolamide (Diamox) as a second-line therapy.
The interventions were placebo, low-dose betahistine (48 mg/d), and high-dose betahistine (144 mg/d).
The goals of MD treatment are to prevent or at least reduce the severity and frequency of vertigo attacks.

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