Méniére's Disease Vertigo Not Controlled by Oral Pharmacotherapy — What to Do Next

In patients with Méniére's disease whose vertigo attacks have not been adequately reduced or prevented by oral maintenance pharmacotherapy, a more direct intervention targeting the affected ear is the next step addressed by this protocol.

Previous line — insufficient response

Oral maintenance pharmacotherapy — diuretics (thiazide, spironolactone, or acetazolamide) and/or betahistine — did not achieve sufficient reduction of Méniére's disease vertigo attack frequency or severity to constitute adequate control.

Next step — clinical goal

When oral therapy has not achieved adequate vertigo control, the protocol addresses management through a procedural intervention delivered directly to the middle ear. The goal is improved control of Méniére's disease vertigo. The specific agent, volume, and session schedule that constitute the complete regimen are contained in the full protocol.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1177/0194599820909438

Clinicians may offer, or refer to a clinician who can offer, intratympanic (IT) steroids to patients with active Ménière's disease not responsive to noninvasive treatment.
Inject 0.4-0.8 mL into middle ear space, from once only or up to 3 to 4 sessions every 3 to 7 days depending on clinical response.
The goals of MD treatment are to prevent or at least reduce the severity and frequency of vertigo attacks.

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