There is no single treatment for Ménière's disease, mainly because the exact cause is still unknown.

However, your GP and ear, nose and throat (ENT) specialist will be able to help you to manage your symptoms using a variety of techniques. Possible treatments include:

• dietary advice, particualrly a low salt diet
• medication to treat attacks of Ménière's disease
• medication to prevent attacks of Ménière's disease
• treatment for tinnitus
• treatment for hearing loss
• physiotherapy to cope with balance problems
• surgery
• treatment for the secondary symptoms of Ménière's disease (stress, anxiety, and depression)

Your GP and ENT specialist will provide you with advice and information that is tailored to your individual needs, and develop a management plan that will help you to cope more effectively with your symptoms. In some cases, the treatment available may depend on what your local primary care trust (PCT) can provide.

Treatment during an attack

During an attack of Ménière's disease, you may be prescribed medication to treat the symptoms of:

• vertigo (a feeling that the environment around you is spinning)
• nausea (feeling sick)
• vomiting

The medications are usually prescribed for 7-14 days. The medications that are 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

Prochlorperazine can cause side effects including:

• tremors (shaking)
• abnormal, or involuntary, body and facial movements

They 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.

If you are vomiting, there is a type of prochlorperazine, called Buccastem, that you can take. 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 without you having to keep down tablets that you swallow.

Antihistamines

Possible antihistamines include:

• cinnarizine
• cyclizine
• promethazine teoclate

Antihistamines can also 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.

Serious attacks

If your GP, or another healthcare professional who is treating you, is concerned about severe nausea and vomiting during an attack of Ménière's disease, they may inject you with prochlorperazine. They can also give you a tablet of prochlorperazine that dissolves very quickly in your mouth (Buccastem - 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.

Preventing attacks

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.

Special diets

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, such as tea and coffee, is also usually recommended.

If you have migraines (severe headaches), avoiding possible migraine triggers may prove beneficial. Known migraine triggers include chocolate, nuts, and some red wines.

Betahistine

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.

Treating tinnitus

There are a number of different treatment options that can be used to treat tinnitus that is 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) - is a talking therapy that is based on the idea that your thoughts affect the way that you behave. Treatment aims to retrain the way that you think in order to change your behaviour so that you can cope more effectively with your tinnitus.

Your GP can refer you to a hearing therapist to discuss these techniques in more detail. See the Health A-Z topic about Tinnitus - treatment for more information, or the useful links section.

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 the Royal National Institute for Deaf and Hard of Hearing People (RNID) can provide you with helpful advice for dealing with hearing loss.

See the Health A-Z topic about Hearing impairment - treatment, or the useful links section, for more information.

Physiotherapy

A physiotherapist can help you to improve your balance by teaching you vestibular rehabilitation techniques. These are exercises that 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 that it would benefit you.

See the Health A-Z topic about Physiotherapy for more information. 

Surgery

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 can either have:

• destructive surgery, or
• non-destructive surgery

Destructive surgery

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 (dB), 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 lost 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.

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 as well.

Some surgeons prefer to apply the gentamicin directly to the inner ear during a minor operation. This enables the exact dose of gentamicin that enters your ear to be controlled.

Non-destructive surgery

Non-destructive surgery may be used if your hearing in the ear that is affected by Ménière's disease is 'socially adequate' (you can hear sounds that are below 50 dB). 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 endolymph fluid (the fluid inside the labyrinth in your inner ear)
• inserting ventilation tubes - these are inserted into you ear to reduce the changes in pressure that cause Ménière's disease, or
• injecting steroids through the eardrum (steroids are a type of medicine that contain powerful chemicals called hormones) - this is a new type of treatment that has not yet been proven to be beneficial

Results

There are very few 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. 

Treatments for the secondary symptoms

As Ménière's disease is a difficult and unpredictable condition, it can often lead to the secondary symptoms of stress, anxiety and/or depression.

More information about these conditions and possible treatments can be found in the Health A-Z and in the useful links section of this topic. Some possible treatments are described below.

• Counselling - is a talking therapy that allows you to talk about your feelings and the problems that you are experiencing, as well as discussing ways of improving your quality of life by learning to cope with the attacks of vertigo and hearing loss.
• Psychotherapy - is a talking therapy that helps you understand and accept your strengths and weaknesses and identify what makes you feel upset, or anxious, so that you can change your attitudes and behaviour.

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 that 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. The Royal National Institute for Deaf and Hard of Hearing People (RNID) also has a dedicated section about Ménière's disease.

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 able to help. See the useful links section for more information.

If you are caring for someone with Ménière's disease, you can use Carers Direct to find relevant information, advice, and support.

Vertigo

Vertigo is the sensation that you or the environment around you is moving or spinning.

Tinnitus

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.