Ménière’s Disease: A Diagnosis of Exclusion with Controversial Therapies

This procedure involves ablation of the diseased inner ear organs. Because it can be performed through a basic mastoidectomy or transcanal approach and does not require entry into the cranial cavity, it is less complex than a vestibular nerve section. Labyrinthectomy has a high cure rate for controlling vertigo attacks, similar to vestibular nerve section.

Regardless of which of these two surgical therapies is done, patients who participate in vestibular rehabilitation afterwards demonstrate significant improvement in balance function,14 according to Dr. Hoffer.

Vestibular rehabilitation is a relatively new application for Ménière’s disease because general rehabilitation is usually only good for disorders that are constant, said Dr. Hoffer. Due to the fluctuating nature of Ménière’s disease and its unpredictability, vestibular rehabilitation would appear to have a limited role as a treatment option. As it turns out, it works well because of the underlying disequalibrium that is present in and frustrating for most patients with Ménière’s disease.

Even if you can stop the fluctuation of symptoms, patients will still have the unsteadiness; vestibular rehabilitation is physical therapy for the balance system, continued Dr. Hoffer. More hospitals are developing a balance therapy program where patients with all types of balance and hearing disorders can be evaluated.

Other Treatment Options

If patients don’t respond well to any of these treatments, then other, not-so-standard options may be considered. Some otolaryngologists are trying:

• Vasodilators/calcium channel blockers (verapamil), as they are used to treat migraine-associate vertigo.
• Antihistamines, such as betahistine (Serc), which is available only in Canada and Europe.
• Antiviral therapy, such as acyclovir.
• Immunologic therapy.
• Intratympanic and systemic steroids (dexamethasone, prednisone, methylprednisoline).

There is growing research regarding intratympanic steroids; it will be exciting to see their short and long-term benefits and where they ultimately fit in amongst the treatment options, said Dr. Megerian.

Evidence shows that a single injection of steroids may be ineffective, as the steroids do not remain in the ear for long; however, multiple injections per year or those done on an as-needed basis appear more effective and to have longer-lasting results.4 Some researchers are mixing steroids with hyaluronic acid, because of its viscosity, to see if they would remain in the ear longer. Transtympanic perfusion using steroids is considered a nondestructive procedure and success rates near 90% have been reported.13

Finally, the Meniett device is designed to reduce vertigo by delivering pulses of pressure to the inner ear via a tympanostomy tube; some patients have symptomatic relief when the device is used on a daily basis.

Future Promises

Since it’s so common, Ménière’s disease has been highly researched and fascinated our profession for years, yet that ‘golden ring’ of how to prevent endolymphatic hydrops from occurring still eludes us, said Dr. Hoffer.