Medical treatment of Meniere's disease can be divided into two parts: acute attack treatment and prophylactic treatment to prevent attacks. If endolymphatic hydrops develops as a result of another disease, this condition is called Meniere's Syndrome, not Meniere's Disease, and the causative disease is treated. There are many diseases that can cause Meniere's disease. Many problems, from systemic diseases such as syphilis and thyroid diseases to ear diseases such as temporal bone fractures, acoustic neuroma, otosclerosis, sac tumors, can cause endolymphatic hydrops and must be eliminated at the diagnosis stage.
Acute. Attack patients are usually seen in the emergency room. It may be necessary to insert a fluid to prevent dehydration due to vomiting. To reduce symptoms, agents that suppress the central nervous system, the urge to vomit, and the feeling of vertigo, such as meclizine, dimenhydrinate, and diazepam, are preferred. Some authors also recommend the use of steroids during an attack. (Barrs, D. M., J. S. Keyser, C. Stallworth, et al. (2001). "Intratympanic steroid injections for intractable Meniere's disease." Laryngoscope111(12): 2100-4.)
Prevention of attacks in Meniere's treatment Treatment is highly controversial. First of all, patients are recommended a diet. This diet is usually salt restriction, but there are also authors who recommend caffeine, chocolate, coffee and alcohol restrictions. Almost none of these dietary treatments have been proven by serious studies. However, it is theoretically thought that excessive salt consumption may affect the level of endolymphatic pressure. On the other hand, there are those who oppose this theory because the dynamics of inner ear fluids are different from peripheral circulation. Regardless, it seems logical that patients should not add additional salt to their meals. Those who recommend other food restrictions focus more on the food allergy – Meniere relationship. Food allergy is an autoimmune reaction, and authors who believe in auto-immune involvement state that the endolymphatic sac is an immunological organ. Dornhoffer et al showed 40% IgG accumulation in the endolymphatic sac. (Dornhoffer JL, Warner M, Arenberg IJ. Immunoperoxidase study of the endolymphatic sac in Meniere's disease. Laryngoscope 1993;103:1027-34.) On the other hand, coffee restriction should be avoided if food allergy occurs. If it is not related, it is not considered logical by the author, because the increase in alertness provided by coffee may be related to the stimulation of nicotinic receptors. In our yet unpublished study, high dose betahistine probably causes caloric hyperreflexia by stimulating histaminic receptors. This condition, which may lead to more severe vertigo during a seizure, probably reduces the likelihood of seizures by increasing central inhibition between seizures. On the contrary, it can be expected that coffee may be beneficial due to its alertness similar to betahistine and thus its inhibitory effect on the vestibular nuclei.
The most commonly used agents in medical treatment to prevent attacks are diuretics. Acetazolamide, which is also used for eye pressure, is among these. Ca channel blockers such as verapamil are also among the agents used in treatment.
High dose betahistine has been shown to be effective in preventing meniere's attacks. Using low doses of this drug probably does not work. Strupp, M., D. Hupert, et al. (2008). "Long-term prophylactic treatment of attacks of vertigo in Meniere's disease--comparison of a high with a low dosage of betahistine in an open trial." Acta Otolaryngol 128(5): 520-4.
If medical treatment is not successful and Meniere's Disease continues to a level that prevents the patient from daily life, invasive treatments are used.
The next step of gentamicin treatment is surgical treatments. . Endolymphatic sac decompression, a hearing-preserving surgical method, is far from providing reliable control results. It is possible to clear all vestibular neuro-epithelium with the labyrinthectomy operation performed via the transmastoid route, but hearing is lost. This surgical approach provides control rates as high as 97-100%. Kemink JL, Telian SA, Graham MD, et al. Transmastoid labyrinthectomy: reliable surgical management of vertigo. Otolaryngol Head Neck Surg 1989;101(1):5-10. Langman AW, Lindeman RC. Surgical labyrinthectomy in the older patient. Otolaryngol Head Neck Surg 1998;118(6):739-42.
Vestibular nerve transection is a surgery that preserves hearing and eliminates the vestibular system in cases that do not respond to gentamicin treatment (which is very rare).
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