There is no single treatment for Ménière's disease, mainly because the exact cause is still unknown.
However, your ear, nose and throat (ENT) specialist and your GP will be able to help you manage your symptoms using a variety of techniques. Possible treatments include:
Your GP and ENT specialist will provide you with advice and information tailored to your individual needs, and will develop a management plan to enable you to cope more effectively with your symptoms. In some cases, the treatment available may depend on what your local primary care trust can provide.
Treatment during an attack
During an attack of Ménière's disease, you may be prescribed medication for 7-14 days to treat the symptoms of:
The medications usually prescribed are prochlorperazine or an antihistamine.
If these medicines are successful in treating your symptoms, you may be given a supply to keep at home so that you can take them the next time you have an attack.
Prochlorperazine can cause side effects including:
- tremors (shaking)
- involuntary body and facial movements
It can also make some people feel sleepy. Check the patient information leaflet that comes with your medicine for the full list of possible side effects, or read more about prochlorperazine here.
If you are vomiting, you can take a type of prochlorperazine called Buccastem. This comes as a tablet that you place between your gums and your cheek on the inside of your mouth. The tablet dissolves and is absorbed into you body.
Possible antihistamines include:
Antihistamines can make you feel sleepy. Headaches and an upset stomach are also possible side effects. Check the patient information leaflet that comes with your medicine for the full list of possible side effects.
If you suffer severe vertigo, dizziness, nausea and vomiting during an attack of Ménière's disease, your doctor may inject you with prochlorperazine.
If you suffer severe vertigo with or without nausea during an attack, your doctor may also prescribe you a tablet of Buccastem that dissolves very quickly in your mouth (see above).
In very severe cases, you may need to be admitted to hospital to receive intravenous fluids (through a vein) to keep you hydrated.
Your GP can prescribe a medication called betahistine to help reduce the frequency and severity of attacks of Ménière's disease, or you may be advised to change your diet.
Although it has not been proven, following a diet without added salt does seem to help control Ménière's disease. It is possible that this type of diet might alter the fluids in your inner ear. Avoiding excessive caffeine, found in drinks such as tea and coffee, is also usually recommended.
If you have migraines, avoiding possible migraine triggers may prove beneficial. Known migraine triggers include chocolate, nuts and some red wines.
It is thought that betahistine reduces the pressure of the fluid in your inner ear, relieving the symptoms of Ménière's disease. Research that has been carried out into betahistines has not found enough evidence to confirm whether they are effective. However, your GP may recommend trying them.
Betahistines are usually available as tablets to be taken three times a day. Your GP will discuss how long you need to take them for, which could be a few weeks, or up to a year. Possible side effects include a headache, upset stomach and a skin rash.
Read more about betahistine.
There are a number of different treatment options that can be used to treat tinnitus caused by Ménière's disease. Some possibilities are described below.
- Sound therapy - the effects of tinnitus are often more pronounced in quiet environments. Sound therapy works by reducing the difference between the tinnitus sounds and the background sounds. This makes the tinnitus sounds less intrusive.
- Relaxation techniques - tinnitus can be a distressing and intrusive condition. Relaxing by practising yoga or special breathing techniques may help you to avoid stress and anxiety.
Cognitive behavioural therapy (CBT) - this is a therapy based on the knowledge that severe Ménière's disease symptoms (especially tinnitus and vertigo) have a significant psychological effect, resulting in negative thoughts and avoidance behaviour, which in turn aggravates your symptoms and creates a vicious circle. This treatment is given by a specially trained professional, who aims to change the way you think and behave, which would allow you to cope better with your symptoms and engage more effectively in the treatment.
Your GP can refer you to a hearing therapist to discuss these techniques in more detail. Read about the treatment of tinnitus for more information.
Treating hearing loss
If your Ménière's disease is in the middle or end stages, you may experience some permanent hearing loss. Ménière's disease tends to make you more sensitive to loud sounds, and also makes it more difficult for you to distinguish low-pitched sounds.
There are a variety of hearing aids available that may be suitable for you. Hearing therapists and organisations, such as Action on Hearing Loss, can provide you with helpful advice for dealing with hearing loss.
Read more about the treatment of hearing impairment.
A physiotherapist can help improve your balance by teaching you vestibular rehabilitation techniques. These exercises teach you how to cope with the abnormal and disorientating signals coming from your inner ear. You are taught to use alternative signals from your eyes, ankles, legs and neck, to keep you balanced.
Physiotherapy is usually used in the middle or late stages of Ménière's disease, after the severe attacks of vertigo have stopped but when balance problems may remain. Your GP will be able to refer you to a physiotherapist if they feel it would benefit you.
Read more about physiotherapy.
In severe cases, surgery can be performed to control the attacks of vertigo. However, surgical procedures are usually only used if other treatments have failed. About 10% of people with Ménière's disease will require surgery.
The type of surgery you have will depend on your symptoms, and whether both ears are affected. You could have:
- non-destructive surgery
- selectively destructive surgery
- destructive surgery
Non-destructive surgery may be used if your hearing in the affected ear is 'socially adequate' (you can hear sounds that are below 50 decibels). This type of surgery aims to change the progression of Ménière's disease by reducing the severity and frequency of your symptoms.
Non-destructive surgery could be:
- endolymphatic sac decompression - this reduces the pressure in your inner ear by increasing the drainage of the fluid of your inner ear
- inserting ventilation tubes - these are inserted into your ear to reduce the changes in pressure that cause Ménière's disease
- injecting steroid medication through the eardrum - this is a new type of treatment that has not yet been proven to be beneficial
Selectively destructive surgery
In selectively destructive surgery, the balance part of the inner ear is destroyed with a medicine called gentamicin. This is injected through the ear drum (the thin layer of tissue that separates the outer ear from the middle ear) and enters the labyrinth (the system of tubes in the inner ear).
Gentamicin should mainly cause damage to the balance part of your ear. However, it does carry a risk of damaging your hearing too.
Some surgeons prefer to apply the gentamicin directly to the inner ear during a minor operation. This means they can control the exact dose of gentamicin that enters your ear.
Destructive surgery may be considered if only one ear is affected by Ménière's disease. The hearing in the affected ear must be considered to be 'socially inadequate' (you cannot hear enough to function in social situations). As an approximate guide, if you cannot hear sounds that are below 50 decibels, this may count as socially inadequate.
Destructive surgery is used to destroy the part of your inner ear that is causing your vertigo attacks. Therefore, this type of surgery will only be considered if the hearing loss from the affected ear is permanent.
The destructive surgery could be done by:
- destroying the balance part of your audio-vestibular nerve (the nerve that transmits sounds and balance information to the brain), or
- destroying part of your vestibular labyrinth (the system of tiny, fluid filled channels in the ear) - this procedure is called a labyrinthectomy
After the surgery, your other ear will take over your hearing and balance functions.
There are very few clinical trials (medical tests) looking into the effect of surgery on Ménière's disease, which is why surgery is rarely considered. If your ENT specialist thinks that you may benefit from having surgery, they will discuss the procedure and any risks in more detail with you.
Support groups and charities
There are several support groups and charities that can provide you with useful information and advice about living with Ménière's disease. They can also put you in touch with other people who have the condition so you can share experiences and provide support to one another.
The UK Ménière's Society offers a range of resources and information for people with Ménière's disease and for those who care for them. You can also find a factsheet about Ménière's disease on the Action on Hearing Loss website.
As the symptoms of Ménière's disease can affect your work and family life, you may need advice on financial and relationship issues. The Citizens Advice Bureau and the Directgov website may be useful.
If you are caring for someone with Ménière's disease, you can use Carers Direct to find relevant information, advice and support.
Vertigo is the sensation that you or the environment around you is moving or spinning.
Tinnitus is the medical name for the perception of noise in one ear, both ears or in the head. The noise comes from inside the body rather than an outside source.