Ménière’s disease - Treating Ménière's disease

Treatment can usually help to control the symptoms of Ménière's disease, although there's currently no cure.

Your ear, nose and throat (ENT) specialist and your GP can help you manage your symptoms. Possible treatments include:

dietary advice – particularly a low-salt diet
medication to treat and prevent attacks
treatment for tinnitus
treatment for hearing loss
treatment called vestibular rehabilitation to cope with balance problems
treatment for stress, anxiety and depression
surgery

Your GP and ENT specialist should provide you with advice tailored to your individual needs, and should develop a plan to help you manage your symptoms.

In some cases, the treatment available may depend on what your local NHS Clinical Commissioning Group (CCG) can provide.

Treatment during an attack

During an attack of Ménière's disease, you may be prescribed medication to treat the symptoms of vertigo, nausea and vomiting.

This is usually prochlorperazine or an antihistamine. If these work, you may be given a supply to keep, so you can take them quickly during an attack.

Prochlorperazine

Prochlorperazine can cause side effects including tremors (shaking) and involuntary body or 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.

If you experience vomiting during your attacks, 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 your body.

Antihistamines

Antihistamines you may be prescribed include cinnarizine, cyclizine and promethazine teoclate.

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, or read more about the side effects of antihistamines.

What to do during an attack

During an attack, take your medication as soon as possible and grab the nearest available support. Get into a position in which you feel most stable or comfortable, and keep as still as possible. If you need to move, do so slowly and carefully. Close your eyes or keep them fixed on objects in front of you, and don't turn your head quickly.

Once your symptoms start to improve, it's best to gradually try to move around, as this encourages your brain to use your vision and other senses to compensate for the problems in your inner ear.

Severe attacks

If you suffer severe vertigo, dizziness, nausea and vomiting during an attack of Ménière's disease, you may need to be injected with prochlorperazine by your doctor.

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 particularly 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 to be consistently effective, following a diet without added salt can help some people to control their symptoms. It's 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.

Betahistine

Betahistine is thought to reduce the pressure of the fluid in your inner ear, relieving the symptoms of Ménière's disease. Your GP may recommend trying them to see if they help.

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 rash.

Treating tinnitus

A number of different treatments can be used to treat tinnitus caused by Ménière's disease. Some possibilities include:

Sound therapy – the effects of tinnitus are often more pronounced in quiet environments. The aim of sound therapy is to fill the silence with neutral, often repetitive sounds to distract you from the sound of tinnitus.
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 Ménière's symptoms can have a significant psychological effect, resulting in negative thoughts and changes in behaviour. This may aggravate your symptoms and create a vicious circle. CBT is given by a specially trained professional who aims to change the way you think and behave, to break this cycle.

Treating hearing loss

You may experience permanent hearing loss if Ménière's disease is in the middle or end stages. 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. Hearing therapists and organisations, such as Action on Hearing Loss, can provide you with helpful advice for dealing with hearing loss.

Vestibular rehabilitation

Vestibular rehabilitation (VRT) is usually provided by a hearing specialist or physiotherapist. Your GP may be able to refer you for VRT, although it will depend on the availability in your area.

A vestibular therapist or specially trained physiotherapist can help improve your balance by teaching you vestibular rehabilitation techniques. These exercises teach you how to cope with the disorientating signals coming from your inner ear. You're taught to use alternative signals from your eyes, ankles, legs and neck, to keep you balanced.

Vestibular therapy 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.

In some cases, it may be possible to use VRT without specialist help. Research has shown that some people can improve their symptoms by using self-help VRT booklets. However, you should discuss this with your doctor first. If it's likely to be useful, you can download a copy of these booklets from the Ménière's Society.

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.

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

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.

Types of non-destructive surgery include:

endolymphatic sac decompression – this can help to reduce the pressure in your inner ear by increasing the drainage of the fluid of your inner ear, although evidence of its effectiveness for Ménière's disease is limited
inserting ventilation tubes (grommets) – these are inserted into your ear to reduce the changes in pressure that cause Ménière's disease
injecting steroid medication through the eardrum – although there's only limited evidence to suggest that this is an effective treatment
micropressure therapy – a newer type of treatment with little evidence regarding its safety and effectiveness; grommets are inserted into your ear and attached to a small pressure generator for a few minutes, several times a day, to alter the pressure in the inner ear

The National Institute for Health and Care Excellence (NICE) has more information on micropressure therapy for Ménière's disease.

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 separating the outer ear from the middle ear) and enters the labyrinth (the system of tubes in the inner ear).

Gentamicin should mainly damage the balance part of your ear, but there's a risk it could damage your hearing as well.

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

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 can't hear enough to function in social situations). As an approximate guide, if you can't hear sounds below 50 decibels, this may count as socially inadequate.

Destructive surgery is used to destroy the part of your inner ear causing your vertigo attacks. However, these operations can cause permanent hearing loss in the treated ear, so will only be considered if you already have permanently reduced hearing in the affected ear.

Destructive surgery can be done by:

destroying the balance part of your audio-vestibular nerve – the nerve transmitting sounds and balance information to the brain
destroying part of your vestibular labyrinth (labyrinthectomy) – the system of tiny, fluid-filled channels in the ear

After surgery, your other ear will take over your hearing and balance functions.

Safety and effectiveness of surgery

There are very few clinical trials looking into the effectiveness of surgery for Ménière's disease, which is why surgery is rarely considered. If your ENT specialist thinks you may benefit from having surgery, they'll 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 with the condition.

See living with Ménière's disease for more information.

Ménière's disease and the placebo effect

The placebo effect is the unusual psychological effect that can occur when a person is given a "dummy" medication, such as a sugar pill. They feel better after taking the pill, because they think they're being given real medication.

Although there's limited scientific evidence to suggest that many of the self-help measures and treatments used for Ménière's disease are consistently effective, they can help some people to control their symptoms because of the placebo effect.