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Meniere's Disease Treatment
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Meniere's Disease Treatment
Table of Contents
|
Treatments Are and Always Have
Been Listed Here in Rough Order Of Least Invasive, Least Costly,
Increasing to Most Invasive, Most Costly. |
- There is no cure.
- There is no known cause of Meniere's
Disease, there is no known cure for Meniere's Disease, and there is no
cure on the horizon. That's not "negative thinking"; that's
simply the fact of the matter and there is no point in denying it or
offering false or gratuitous hope. Click
here to see the latest research. The good news is that
Meniere's Disease is not fatal, that there are many possible
"symptomatic" treatments (treatments for the symptoms) with which
patients can try to lessen or at least manage their symptoms, and that
some patients experience temporary spontaneous remissions of varying
periods of time. However, some patients are unresponsive to
virtually all treatments, including invasive surgery, and will become
disabled. See this and other pages
of this website for further information.
Treatment in brief.
- Most, but not all, treatments are for symptoms
believed to be caused by excess endolymphatic fluid. Unless
otherwise indicated, the treatments described below appear to be
founded on the theory that Meniere's Disease symptoms result from
excess endolymphatic fluid in the inner ear ("idiopathic endolymphatic
hydrops.") While this is the prevailing theory, it is not the
definitive theory.
Strategies for obtaining treatment.
- Sometimes patients are confounded in their quest
for treatment because there is no qualified doctor in their town.
The solution to this problem is simple:
go out of town.
- Visit our doctors
page for strategies on obtaining a treatment plan from an out-of-town
specialist who coordinates treatment with your local doctor.
Which treatments work.
- No one treatment works for everyone, yet every
treatment seems to work for someone. We each seem to respond
differently to various treatments. Some patients are nearly
symptom-free just by observing a low-sodium diet (see below). Other
patients may need more complex and/or more invasive treatment.
Other patients seem unresponsive to any treatment -- even invasive
surgery.
- The bottom line: each patient tries to
find the treatment (or treatments) that works best for each one of us.
- Our lay and
inexpert speculation: perhaps there are ten (or more or fewer)
currently unknown diseases that each have the same symptoms as what we
now call "Meniere's Disease," and we each have one (or perhaps two or
three) of the ten (or more or fewer) of the currently unknown
diseases. *IF* this is true, then ten patients could be diagnosed with
"Meniere's Disease," yet each one could have a different disease, and
each one could respond differently to various treatments.
Note on temporary spontaneous
remission.
While not a
"treatment," some patients experience temporary unexpected
("spontaneous") remission (cessation or reduction in symptoms) lasting
days, weeks, months, or even years. There is no way to determine
who will, or who won't, experience temporary spontaneous remissions,
and there is no way to determine how long a temporary spontaneous
remission might last.
Treatment though clinical trials.
The U.S. government has a website for
information on clinical trials:
www.clinicaltrials.gov.
- These clinical trials are usually conducted by the
NIH (National Institutes of Health). In the usual clinical
trials, there are two groups, the test group and the control group.
The test group is treated in some way. The control group is
"pretend-treated," usually with a placebo ("fake") drug. Studies
may last one year, more or less. The results of both groups are
compared to see whether patients in the test group improved
significantly compared to the control group. You might or might
not like to participate in a study. Remember, one group
will always be given placebo ("fake") treatment. However,
control groups are necessary in research and patients in the control
group make very useful contributions to medical science. If you
are interested in participating in a clinical trial, talk to your
doctor.
The International Federation of
Pharmaceutical Manufacturers and Associations (IFPMA) has a website
for searching for clinical trials:
www.ifpma.org/clinicaltrials.html.
- This website searches the U.S. NIH
site,
http://www.clinicaltrials.gov, and in addition searches other
information sources at the same time, providing all the results
together.
Treatment with dietary and lifestyle adjustments.
- Purpose. The purpose of dietary and
lifestyle modification therapies is to reduce all symptoms by reducing
conditions that may initiate or exacerbate (worsen) symptoms.
Sodium (salt)
avoidance.
- Physicians frequently prescribe a low-salt diet
to reduce the amount of sodium in the body.
- Sodium in the body increases fluid retention.
Common table salt is, of course, sodium chloride, and is normally the
primary source of sodium in the body. On the theory that
Meniere's Disease symptoms may result from excess endolymphatic fluid
in the inner ear, physicians often counsel patients to reduce overall
fluid in the body, with the hope that endolymphatic fluid will be
reduced in the process. To reduce sodium intake and, therefore,
reduce bodily fluids, physicians often counsel a low-salt diet and, in
addition, prescribe diuretics to
further reduce the bodily fluids.
- Results vary.
- Some patients anecdotally report a strong
correlation between salt ingestion and onset or worsening of symptoms.
Other patients anecdotally report no correlation between salt and
symptoms at all.
- What's a low-sodium (low-salt diet)?
- Descriptions vary. Some say the less the better.
Some degree of sodium intake is necessary to stay healthy. Many
patients attempt to keep their sodium intake under 1,000 mg. per day.
A few say that they succeed. Ask your doctor how much sodium is
right for you.
- Low sodium websites.
-
LivingLowSodium.com. One of the proprietors has Meniere's
Disease (as stated
here). Books, snacks, soups, sauces, salad dressings,
and more. Friendly, artistic site design.
-
Saltwatcher.com. Online resource
with low-sodium information and recipes; also has food products for
sale online.
- Low
Sodium Cooking.
Great site! Quote: "A can of chili may
contain 2400 mg [of salt] all by itself; homemade chili may contain
less than 100 mg." Need we say more?
- Salt Free
Life. Terrific low-cost membership
website! You don't have to do low salt to love the recipes, reviews,
and cooking tips. Non-members get a free recipe every month. Members
may access an archive of over 240 recipes with new recipes posted
every month. Now your family will love and share the low- and no-salt
meals that you have to have. You can have dinner guests again without
guilt! (No, we do NOT get paid to say this!)
Dr.
Salt's Salt Page (Washington University).
Alec Salt, Ph.D., is the author of this page
on, ironically, salt; it is addressed specifically to Meniere's
Disease patients.
Low sodium books.
(We do *not* get a commission.)
Alcohol avoidance.
- Some patients report that alcohol intake is
devastating. Others report no effects whatsoever on their Meniere's
Disease symptoms after imbibing.
Caffeine avoidance. Many patients report that caffeine intake is
devastating. Some patients report that caffeine has no effect
whatsoever on their Meniere's Disease symptoms.
Nicotine avoidance. Physicians nearly always prescribe cessation of
smoking, and many Meniere's Disease patients -- who can -- quit out of
necessity.
Stress avoidance. Stress is suspected to have a role in Meniere's
Disease, although stress is not well suited for objective measurement
and is not well documented.
Trigger avoidance and treatment.
- While the cause of Meniere's Disease is unknown,
there are "triggers" that can (for known or unknown reasons) initiate
or exacerbate (worsen) symptoms in *some* patients. Most patients find it helpful to identify and avoid --
or treat -- triggers, when possible, thereby indirectly treating the
symptoms of Meniere's Disease.
- Triggers known to affect many (but not all)
patients.
- Allergies, including food allergies.
- Allergies, including food allergies, are believed
by many to have a role in triggering Meniere's Disease symptoms in
*some* patients. Treatment of allergies may or may not help
reduce Meniere's symptoms or frequency of occurrences, depending upon
the patient.
- Some patients seek allergy testing in order to see
whether avoidance of allergenic reactions may help to reduce the
frequency and/or intensity of Meniere's Disease episodes.
Anecdotally, this strategy seems to help some patients, but not all
patients.
-
Dr. Jennifer
Derebery, House Ear Institute, Los
Angeles, studies the relationship of allergies to Meniere's Disease.
-
Click here to search PubMed for Meniere's
Disease and allergy research by Dr. Jennifer Derebery.
- Menstruation.
- Some women patients experience Meniere's symptoms
in conjunction with menstruation.
-
Washington University.
- Dr. Gwen Morse and Dr. John House have authored
a
paper describing evidence of a
relationship between the menstrual cycle and Meniere's Disease
responses in some women. "Results from this study provide
evidence that a unique relationship does exist between the menstrual
cycle and Meniere's disease responses for some women. Knowledge gained
from this study is beneficial in identifying the importance of
appropriate clinical assessment methods of menstruate women with
Meniere's disease. Recommendations include further research with
larger samples and testing of different symptom management strategies
for women of different perimenstrual symptom patterns."
- Pregnancy.
- Some women patients anecdotally report that their
symptoms are exacerbated during pregnancy.
- Some women patients report that their symptoms of
Meniere's Disease first appeared either during pregnancy or soon after
delivery.
- Visual stimuli.
- Some patients anecdotally report that certain
visual events, especially parallel vertical lines, will trigger
dizziness and other symptoms. Here are some examples:
- Streets and highways lined with trees or telephone
poles.
- Supermarket aisles.
- Some motion pictures.
- Barometric pressure.
- Some patients anecdotally report that changes in
barometric pressure can trigger symptoms. Some patients so
affected track weather patterns very closely in an attempt to
anticipate increases in symptoms.
- Other triggers.
- There are literally a million possible triggers,
because each patient is different. The patient's objective is to
identify condition that may be triggers for that patient.
Treatment with complementary and alternative
medicine (CAM).
- In general.
- Cautions.
- Dr. Stephen Barrett's
Quackwatch.
- Logical fallacies.
- In general.
- Post hoc, ergo propter hoc (after this, therefore
because of this).
Datanation.com.
If a patient improves after treatment "x"
(say, grapefruit juice), a patient may think that the grapefruit juice
improved the patient's Meniere's Disease. However, the mere fact
that improvement followed a treatment is not evidence that the
improvement was *caused* by the treatment. (Correlation is not
causation.)
Clinical trials.
The best medical studies (trials) based on science are those that are
randomized, double-blind, placebo-controlled, and that are
subsequently peer-reviewed and published in a professional journal,
and after that are replicated by independent researchers.
Resources
U.S. National Institutes of Health,
Office of Dietary Supplements.
Mayo Clinic,
Complementary and Alternative Medicine Center.
George Washington University,
Center for Integrative
Medicine.
University of Maryland,
Center for Integrative Medicine.
Cochrane Collaboration.
Aetna Intelihealth.
Herbs, vitamins, minerals, and other supplements.
- Cautions.
- There is no medical evidence to support the
effectiveness of herbs, vitamins, or minerals in the treatment of
Meniere's Disease. (See for yourself at
PubMed.) It is always prudent to
thoroughly research the effects and drug interactions of any
medication that you contemplate taking,
whether prescription, over-the-counter (OTC), herbal, vitamin,
mineral, supplemental, or whatever. Talk to your pharmacist and to
your physician.
- Ginkgo biloba.
- Some patients believe that "ginkgo" acts as a
vasodilator that improves blood flow to the head, improving their
symptoms. Other patients report no effect at all. Moreover, ginkgo has
its detractors, who believe that it is a dangerous anti-coagulant,
especially when teamed up with certain other drugs, such as aspirin.
The moral: do your homework; study up before taking any substance, and
be sure to discuss with your physician.
-
Ginkgo and aspirin (student health service, Illinois
State University).
- "Ginkgo
Biloba - A Word of Hope and A Word of Caution," by Dr. Stephen Nagler.
- Ginkgo biloba
information from ivillagehealth.com.
-
Click here to search PubMed for Meniere's Disease and
ginkgo biloba.
Vinpocetine.
Niacin (vitamin B-3; nicotinic acid; nicotinamide).
Bioflavonoids.
Lipoflavonoids.
Ginger root. Ginger root tea is often described by patients
as helpful in reducing nausea.
- Acupuncture.
- Homeopathy.
- Cautions.
- Vertigoheel.
The bottom line: "Results:
Both homeopathic [Vertigoheel] and conventional [betahistine
hydrochloride (often referred to by the brand name "Serc")] treatments
showed a clinically relevant reduction in the mean frequency,
duration, and intensity of the vertigo attacks. The therapeutic
equivalence of the homeopathic remedy [Vertigoheel] and betahistine
[hydrochloride ("Serc")] was established statistically."
- Comment: This study equates the efficacy of
Vertigoheel with the efficacy of Serc (betahistine hydrochloride), but
the efficacy of Serc is itself controversial. See our
page on Serc.
-
Click here to search PubMed for Meniere's Disease and
Vertigoheel.
- Update January 17, 2007:
- We previously believed and reported that
Vertigoheel had been approved by the FDA for the treatment of vertigo
on the basis of the above study, that Vertigoheel was thus available
in the U.S. by prescription only, and that Vertigoheel was listed as a
prescription drug in the Physicians' Desk Reference (PDR) (possibly in
the 1998 edition and possibly on page 1187 of that edition).
- However, today we are unable to confirm through
authoritative sources that Vertigoheel is currently approved by the
U.S. FDA in any respect, that it ever was approved by the FDA in any
respect, or that a prescription is or ever has been required for the
purchase of Vertigoheel. Today, there was virtually no
information about Vertigoheel at the FDA website. Click
here to search the FDA website for yourself. Vertigoheel
is not listed in the 2007 PDR (Physicians' Desk Reference).
- We found that Vertigoheel made by Heel is available
without a prescription from
this source. We
found that a similar product, cocculus compositum, made by Heel, is
available without a prescription from the
same source.
Note: This is news, not advertising, and we receive no
compensation for posting this information.
- We received this email on October 15, 2002: "I receive so many phone calls from people with Meniere's
who have been looking for Vertigoheel to help treat their symptoms and
who have had a lot of trouble finding the product -- anywhere --
that I thought I would write and let you know that I sell Cocculus
Compositum (exact formula as Vertigoheel but you don't need a
prescription) for $18.06 (20% off) and usually ship the next day by
priority mail. [Note that the manufacturer of this product is Heel,
the company that also manufactures Vertigoheel. -- Editor.] My
website is Vitamin-Resource at
http://www.vitamin-resource.com, and there is a direct link to
the Cocculus Compositum tablets [here].
Hope this will be helpful to some of your members. Best wishes,
Joanne Lindon, Vitamin-Resource." Note: This is
news, not advertising, and we receive no compensation for posting this
information.
Ventigoheel.
Chiropractic.
- Cautions.
-
Chiroweb.
"Parkinson's Disease, Meniere's Syndrome,
Trigeminal Neuralgia and Bell's Palsy: One Cause, One Correction," by
Michael T. Burcon, DC (chiropractor), as published in Dynamic
Chiropractic, May 19, 2003, Volume 21, Issue 11.
Osteopathy.
- Cautions.
- Symptomatic relief after treatment of
temporomandibular disorder (TMD) and cervical spine disorders (CSD) in
patients with Meniere's disease: a three-year follow-up.
Abstract at PubMed. According to
the abstract, results showed that a coordinated treatment of TMD and
CSD in patients with Meniere's disease is an effective therapy for
symptoms of this disease. The results suggested that Meniere's disease
has a clear association with TMD and CSD and that these three ailments
appeared to be caused by the same stress, nervousness, and muscular
tension.
Treatment with devices.
- Meniett device.
- The Meniett
device is a portable air pressure pulse generator originally
developed by the Swedish company Pascal Medical AB and now marketed in
the U.S. by Medtronic Xomed.
- December 2006 -- A
study published in the medical journal Archives of
Otolaryngology -- Head and Neck Surgery, published by the American
Medical Association, reports highly encouraging results in a two-year
survey of patients using the Meniett Device. (Arch Otolaryngol Head Neck Surg.
2006 Dec;132(12):1311-6.)
-
Click here to search PubMed for Meniere's Disease and Meniett device.
-
This study shows the Meniett Device and the Enttex P-100
device "beneficial," equally so. The Enttex P-100 device was
preferred for its greater convenience and its much lower cost compared
to the Meniett device.
Enttex P-100 device.
- The Enttex P-100
device debuted in June 2005. It is described as a manual
type of air pressure pulse delivery device, positioned as a lower-cost
alternative to the "expensive device" (obviously, a thinly-veiled
reference to the Meniett
device). There is not yet a great deal of information available
about the P-100.
- 32nd Annual
International Conference of the Neurootological and Equilibriometric
Society (NES) 2005.
- According to this website, the following paper was
presented at the conference: Franz, B., Melbourne, Australia,
P-100 for Treatment of Meniere's Disease, A Clinical Study.
(Enter the site, click on "scientific program" on the left, then click
on "preliminary program" on the bottom, then download "Preliminary
Scientific Program.) Alternatively, click
here. We
have not seen either the study or an abstract.
-
Click here to search PubMed for Meniere's Disease and the P-100 device.
-
This study shows the Meniett Device and the Enttex P-100
device "beneficial," equally so. The Enttex P-100 device was
preferred for its greater convenience and its much lower cost compared
to the Meniett device.
Tinnitus retraining therapy (TRT).
Deep Brain Stimulation (DBS)
device to treat tinnitus.
-
Article on a trial of the DBS device, Rocky Mountain News
(Denver), December 5, 2005.
- The DBS device has previously been used to calm
tremors from Parkinson's disease and other brain-related disorders.
- This patient's tinnitus was so severe that she once
contemplated suicide.
- This patient's doctor is neurosurgeon Bruce Koppel,
M.D., of the Medical College of Wisconsin (MCW), at Froedtert
Hospital.
- Related information --
Electrical stimulation to treat tinnitus.
- A treatment for tinnitus
(resulting from Meniere's Disease or otherwise), which involves
treating the outside of the ear with a small electric current.
- Atlanta
Ear Clinic, Ronald L. Steenerson, M.D.
This site has a
page
on the treatment of tinnitus,
including a description of electrical
stimulation (note that this page is headed "Treatment of Annoying
Tinnitus at the Georgia Tinnitus Clinic"; it is unclear to us how the
"Georgia Tinnitus Clinic" relates to the "Atlanta Ear Clinic").
Treatment with vestibular rehabilitation therapy
(VRT).
- Vestibular rehabilitation therapy
(VRT).
- Bilateral loss of vestibular
function.
Treatment with medicine.
- It is always prudent to thoroughly research the
effects and drug interactions of any medication that you contemplate
taking. Talk to your pharmacist and to your physician.
- Overview.
- Diuretics.
Diuretics are often prescribed
to treat Meniere's Disease, often in conjunction with a low-salt diet
(see above), apparently for the purpose of reducing body fluids in
general and endolymph in particular. This treatment presumes
that the patient suffers from (idiopathic) endolymphatic hydrops
(excess endolymphatic fluid).
- For unknown reasons, a patient's Meniere's Disease
symptoms may not be responsive to one diuretic drug yet may be very
responsive to another diuretic drug. Thus, one should discuss
with one's doctor trying at least two different diuretics before
concluding that "diuretics don't work for me."
-
Notes from the University of Kansas (KU) Medical
Center; scroll down to "treatment."
- Maxzide (sometimes spelled (perhaps incorrectly)
Maxide); Dyazide (generic:
triamterene/hydrochlorothiazide
(HCTZ)).
- Diamox (generic:
acetazolamide).
- Neptazane
(generic:
methazolamide).
Somewhat less commonly, Neptazane, which is often prescribed to treat
glaucoma, is prescribed to treat Meniere's Disease.
Washington University (St. Louis) Physicians;
Emedicine.com.
- Isosorbide.
- An osmotic diuretic named "isosorbide" is used to
treat Meniere's Disease in Japan, according to
this study. (Note: There is an "isosorbide"
(isosorbide
dinitrate), a vasodilator, that is used to treat angina
pectoris (chest pain due to heart disease) in the U.S. The two
are
NOT the same.) Studies of treatment of Meniere's Disease
in Japan with isosorbide date back more than 20 years. Whether
there any reason to think that the osmotic diuretic isosorbide would
be any more effective than the diuretics
triamterene/HCTZ (Maxzide, Diazide) or acetazolamide (Diamox) that are
commonly prescribed in the U.S. is hard to say. Some people seem
to do better on triamterene/HCTZ than acetazolomide, and vice versa.
Perhaps some people would do better on isosorbide and perhaps not.
Like all things Meniere's, nothing is certain.
Antiviral drugs.
- We are hearing anecdotal reports from patients who
are (perhaps by their own demand) being treated with antiviral drugs
such as acyclovir (Zovirax), famciclovir (Famvir), and valacyclovir (Valtrex)
-- with mixed results. This apparently responds to a few studies
finding a tenuous (in our view) connection between the herpes simplex
virus (HSV) and Meniere's Disease. (Read
more at the herpes simplex virus section of our Cause Page.)
No study in PubMed states for a
fact that HSV is a cause of Meniere's Disease. There are
almost no studies to be found at
PubMed on the subject of treating Meniere's Disease with
acyclovir or other antiviral drugs and none that finds that an
antiviral drug is effective in treating vertigo caused by Meniere's
Disease (for example,
this study by Dr. Derebery, et al., of the House Ear Clinic in
Los Angeles).
- "Effectiveness of
Acyclovir on Meniere's Syndrome III Observation of Clinical Symptoms
in 301 cases," Mitsuo Shichinohe, M.D., Ph.D., The Sapporo Medical
Journal, Vol. 68, No. 4-6, December, 1999.
- The full text of this paper is available in
English at Dr. Shichinohe's website
here in
eight separate download files (one download file for each of eight
pages) in .pdf format.
- MenieresInfo.com report, revised April 13, 2007.
- This study is not listed in
PubMed. The Sapporo
Medical Journal is published by
Sapporo Medical University,
Sapporo Japan. The "III" in the title means that this is the
third paper in a series of three authored by Dr. Shichinohe, none of
which appears in PubMed.
The other two papers are cited in footnotes 1 and 2 of this study.
As of January 8, 2007, Dr. Shichinohe is listed as author or co-author
of five articles in PubMed (click
here).
- Results: In this study,
patients were each treated with 2,000 mg/day of acyclovir for an
average period of two weeks. There were 250 patients who were
ultimately evaluated. In 82.5% of cases diagnosed as Meniere's
Disease, 85% of cases diagnosed as Meniere's Syndrome (symptoms of
Meniere's Disease but other basic diseases could not be completely
excluded), and 89.1% of cases diagnosed as vestibular dysfunction,
vertigo disappeared, and tinnitus and hearing were improved. No
side effects were observed.
- Limitations: This study was not randomized,
not double-blind, not blind, and not controlled. As stated in
the study, patients "knew" of the effectiveness of acyclovir and
"wished" the treatment. We have not found any subsequent citations to
this study in PubMed.
We have found no replication of this study. A randomized,
double-blind, placebo-controlled clinical trial of the antiviral drug
famciclovir (Famvir) for reduction of Meniere's disease symptoms by
Dr. Derebery, et al., of the House Ear Clinic in Los Angeles,
reported in 2004, found no "dramatic" effects on "vertigo or
dizziness" and that famciclovir simply "may" suppress the fluctuation
of hearing.
- Comment: Despite the limitations of
Dr. Shichinohe's study, the results are impressive. While a
viral etiology (cause) of Meniere's Disease has not been positively
established, there are researchers who suspect, even in the absence of
persuasive evidence, that a virus, and particularly the herpes simplex
virus (HSV), *may* be a factor in *some* cases diagnosed as Meniere's
Disease. We believe that it can be worthwhile for patients to
discuss this study with their doctors, together with other relevant
studies.
-
Click here to search PubMed for Meniere's Disease and (herpes or
(acyclovir and other antiviral drugs)).
Click here to search PubMed for Meniere's
Disease and acyclovir and other antiviral drugs.
Click here to search PubMed for Meniere's Disease and herpes.
Vestibular sedatives.
- These drugs are intended to sedate the vestibular
system to reduces the effects of vertigo (the spinning sensation).
Not surprisingly, these "vestibular sedatives" can have a side effect
of drowsiness. Yet, some patients complain that the vestibular
sedatives make them drowsy. Such is the nature of medicine:
one trades off the benefit of the treatment in exchange for acceptance
of the side effects. In this case, one makes a choice as to
whether one would prefer vertigo or drowsiness. However, what
many patients fail to understand is that they can work with their
doctors to adjust the dosage of the vestibular sedatives to reach the
point at which the patient is willing to accept the trade-off:
the point at which the vertigo is sufficiently controlled and at which
the patient is willing to accept that particular degree of drowsiness
as a side effect. One's doctor may either adjust the strength of
the prescription or simply advise the patient to break or cut the
pills.
- Valium (generic:
diazepam).
- The purpose of Valium in
treating Meniere's Disease is to prevent or reduce vertigo by sedating
the vestibular system.
Antivert, Meclizine (generic:
meclizine
hydrochloride).
- Antivert (Meclizine) is an
antihistamine that is also a vestibular sedative. The purpose of
Antivert in treating Meniere's Disease is to prevent or reduce vertigo
and hence the resultant nausea by sedating the vestibular system.
- Information on meclizine hydrochloride is available
at
MedLinePlus (NIH).
- Meclizine hydrochloride 25 mg.
tablets may be purchased over-the-counter in the U.S. and elsewhere
under various brand name and private label products sold for car, air,
and seasickness, including Dramamine II and Dramamine Less Drowsy
Formula, Bonamine, and Bonine (but not regular Dramamine, which is 50
mg. dimenhydrinate).
Names and formulations vary and are subject to change; be sure to
read the ingredients and potency listed on the package.
Also available in generic form, over the counter
(but sometimes "behind the counter," meaning one asks the pharmacist
for it but a prescription is not required).
Generic meclizine hydrochloride can be
bought by mail without prescription at Amazon.com and
elsewhere.
Phenergan (promethazine
hydrochloride).
- Phenergan is an antihistamine
and vestibular sedative, the purpose of which in treating Meniere's
Disease is to sedate the vestibular system. Those who are currently
experiencing nausea and vomiting and are unable to "keep down" the
oral form may well find that rectal suppositories of this drug are
much more effective.
May be prepared in a
topical (tube) form for application to the skin (for
absorption through the skin) by a pharmacy if so ordered by a
prescription, but not all doctors and pharmacists are aware of this.
Stugeron, (cinnarizine)
(not available in the U.S.).
- Stugeron is an antihistamine that is also a
vestibular sedative. The purpose of Stugeron in treating
Meniere's Disease is to prevent or reduce vertigo and hence the
resultant nausea by sedating the vestibular system. Stugeron is
commonly prescribed in the U.K. and is not available in the U.S.
Anti-nausea drugs.
- Unlike some diseases and conditions, and some
drugs, Meniere's Disease does not cause nausea. Meniere's
Disease causes vertigo (the spinning sensation), a consequence of
which may be nausea. A consequence of the nausea may be vomiting
-- sometimes severe, even projectile, vomiting. Ideally, one
would control one's nausea by controlling one's vertigo.
However, when attempts at controlling one's vertigo are ineffective,
then one will still want to try to control the consequential nausea.
One of the problems with taking medicine to control nausea is that if
one is already vomiting, one will have difficulty in keeping down and
absorbing oral meds.
- Scopolamine transdermal patch.
- This patch was off the
U.S. market for some time, but it's back. Scopolamine
is sometimes
prescribed as an antiemetic, antinausea drug to treat the
nausea of Meniere's Disease brought on by vertigo.
Phenergan (promethazine
hydrochloride).
- An antihistamine and
vestibular sedative, the purpose of which in treating Meniere's
Disease is to sedate the vestibular system. Those who are currently
experiencing nausea and vomiting and are unable to "keep down" the
oral form may well find that rectal suppositories of this drug are
much more effective.
Ginger root.
- Although ginger root is not a "drug," we mention it
here because so many people find that ginger root, or ginger root tea,
is effective in reducing nausea.
Immunosuppressant (immuno-suppressant) drugs.
- Immunosuppressant drugs include: prednisone,
methotrexate, Enbrel, Remicade, etc.
Treatment of immune-mediated (induced)
conditions.
(Also called immune-mediated,
autoimmune-mediated, and auto-immune-mediated conditions.)
- Some researchers believe that some or all cases of
Meniere's Disease result from, or are aggravated by, an autoimmune
condition in which the immune system is overactive and erroneously
attacks certain normal cells as if they were a threat.
Immune-mediated conditions are difficult to diagnose. There is a
fine line between immune-mediated Meniere's Disease and Autoimmune
Inner Ear Disease (AIED).
-
See: Autoimmune Inner Ear Disease (AIED). Information from Baylor College of
Medicine.
Abstract: Allergic and immunologic aspects of Meniere's
disease (via Pub Med).
Prednisone.
- Prednisone is a
generic name for several branded drugs; it is a steroid, the purpose
of which in treating Meniere's Disease is to suppress the immune
system and/or to reduce inner ear inflammation. You should be
extremely careful in following the prescribed instructions for taking
this powerful drug, especially any instructions regarding a tapered
withdrawal. Prednisone is often prescribed for Meniere's Disease,
sometimes in combination with, or preceding, treatment with
methotrextate (MTX) or other powerful immunosuppressant drugs.
Chronic (long-term) administration of prednisone would have extremely
serious side effects that should be discussed with your doctor.
A doctor who suspects or just wants to confirm or
eliminate the possibility of an immune-mediated etiology (cause) may
prescribe a round of prednisone, even in the absence of diagnostic
tests that indicate an autoimmune etiology. Some patients may not be
responsive to a low-dose trial of prednisone yet may inexplicably
respond remarkably to a high-dose trial of prednisone. If the
patient's symptoms are reduced by the prednisone, then longer-term
immunosuppressant treatment may be recommended.
MedicineNet on prednisone.
Coping With Prednisone (and Other Cortisone-Related
Medicines); It May Work Miracles, but How Do You Handle the Side
Effects? by Eugenia Zukerman and Julie R. Ingelfinger, M.D.
Methotrexate
(MTX).
- This immunosuppressant drug has
been used to treat
suspected immune-mediated cochleovestibular disorders. Note
that methotrexate should be administered carefully and is reported to
have caused deaths. See
the article at RXMED. Still, methotrexate is widely
prescribed for autoimmune diseases, especially rheumatoid arthritis.
Sometimes otologists will prescribe a therapy of methotrexate to be
administered by a rheumatologist who has more experience with
immunosuppressant drugs.
Emerging immunosuppressant drugs.
- There are emerging immunosuppressant drugs, such as
Enbrel and Remicade, that are finding their way into treatment of
suspected immune-mediated Meniere's Disease. Talk to your
doctor.
Serc (betahistine hydrochloride).
- This drug which is widely
prescribed for Meniere's Disease outside of the U.S. Contrary to false
information available elsewhere, this drug under the brand name Serc
may be imported under strict conditions into the U.S., and the generic
equivalent (betahistine hydrochloride) is legally available by
prescription from compounding pharmacists in the U.S.
- See our comprehensive page on
Serc (Betahistine
Hydrochloride)
for more information,
Histamine.
Lidocaine (also see licodaine under surgical,
below).
- The purpose of using
lidocaine in the treatment of Meniere's Disease is to treat the
symptom of tinnitus. There has been an early report that
indicates that lidocaine drops in the nose may help to reduce tinnitus
in some patients. This therapy is in its infancy all over again. The
potential of the "cains" for relieving tinnitus was first observed
long ago.
-
FDA on lidocaine and tinnitus.
-
Retrospective case review
on the administration of lidocaine to treat tinnitus by
Dr. John J. Shea, Jr., and presented at the American Otological
Society Annual Meeting in Orlando, Florida, May 13, 2000. This
paper is not reported in PubMed.
- Novocain (procaine hydrochloride)
was long ago found to have some tinnitus-relieving properties.
Xylocaine (lidocaine hydrochloride) is in current vogue.
-
Click here to search PubMed for lidocaine and tinnitus.
Treatment with surgery.
- Overview.
- Surgical talk.
- According to
this "erratum" note in a medical journal, many patients who are
scheduled for surgery experience remission before the surgery is
actually performed.
The authors
suggest scheduling surgery two months in advance, possibly not in
earnest, to see whether simply scheduling the surgery will produce
remission.
Tubes.
- Pressure equalization (PE) tubes, tympanostomy
tubes, myringotomy tubes,
ventilation tubes, and grommets.
The middle ear is "ventilated" by virtue of a
structure called the Eustachian tube. This tube connects the middle
ear to the pharynx (throat). It is like a valve that opens and closes.
When it opens, air pressure in the middle ear is equalized with the
outside air pressure. The Eustacian tube typically opens during
yawning and swallowing. The the function of the Eustacian tube,
and the state of air pressure in the middle ear, can be tested by
means of a tympanogram.
If the Eustachian tube is becomes dysfunctional by
blockage due to congestion, infection or otherwise, air pressure in
the middle ear can occur to the point of pain. Congestion and
infection may be treated by decongestants, antihistamines, and
antibiotics (if the infection is suspected to be bacterial in nature).
For chronic (continuing) cases, doctors sometimes
create an alternate opening to middle ear from the outer ear by
creating an opening in the eardrum and by inserting a tube called a
"pressure equalization (PE) tube" or a "ventilation tube" or,
sometimes (especially in Australia), a "grommet." ("Pressure
equalization" means "air pressure equalization.") When a PE tube
is in place, there is a continuous opening in the eardrum, and air
pressure in the middle ear is continuously "equalized" with the air
pressure outside of the middle ear. Infants suffering from middle ear
infections (otitis media) often have PE tubes inserted.
The symptom of fullness that is experienced with
Meniere's Disease feels just like air pressure in the middle ear --
but it is *not* air pressure in the middle ear. Meniere's Disease does
not affect the middle ear. Meniere's Disease has nothing to do
with the Eustachian tube, and the typical Meniere's Disease patient
has a fully functioning Eustachian tube. If so, adding a PE tube
wouldn't seem to accomplish anything. Nonetheless, doctors sometimes
insert PE tubes into patients who have fully functional Eustachian
tubes, and the patients sometimes report improvement with their
symptoms, possibly (or probably) due to a placebo effect.
Click
here to read Dr. Timothy Hain's comments on PE tubes.
Click here to search PubMed for Meniere's Disease and pressure
equalization (PE) tubes (also called ventilation tubes and grommets).
Intratympanic
instillation and perfusion of drugs.
- Also called transtympanic instillation and
perfusion of drugs.
- Intratympanic (through the tympanic
membrane (ear drum)) instillation (insertion) and perfusion ("seeping"
through the round window separating the middle ear from the inner ear)
of various drugs, including dexamethasone (DMZ) (Decadron),
streptomycin, and gentamicin).
- Note: The October 2004 issue (Vol. 27, pp.
955-1113) of "Otolaryngologic
Clinics of North America" is devoted to "Intratympanics (sic)
Treatment of Inner Ear Disease." The titles of the 10
substantive articles inside appear relevant and interesting to
Meniere's Disease patients. Click
here
to view the contents. Viewing the full text is trickier. There
is a 30 day
trial, there is access to individual articles, and there is
access to purchasing a full issue. A more practical means of access is
to visit a hospital or medical school library. (See our
research page.)
- Graphic (click to enlarge).
Click to Enlarge
- Drugs used in intratympanic instillation and
perfusion.
- Some corticosteroid drugs are
used, perhaps among other purposes, to (1) reduce inflammation and (2)
to suppress the immune system.
-
Dexamethasone (DMZ) (Decadron).
- The apparent purpose of
intratympanic instillation and perfusion of DMZ is to reduce
inflammation and to suppress the immune system very directly, perhaps
together with or followed by additional DMZ administered intravenously
and/or orally. Apparently, this therapy presumes that inflammation
and/or an autoimmune (overactive immune) condition is causing or
contributing to the symptoms. DMZ is apparently not believed to be
ototoxic. Some physicians believe that this procedure has great
potential for relieving vertigo while preserving, and in some cases,
even improving hearing. Others disagree. As always, see your physician
for medical advice.
-
Click here to search PubMed for Meniere's Disease and
Dexamethasone (DMZ) (decadron).
- August 10, 2005 -- A study on the use of
intratrympanic dexamethasone to treat Meniere's Disease has been added
to PubMed:
Dexamethasone inner ear perfusion by intratympanic injection in
unilateral Meniere's disease: a two-year prospective,
placebo-controlled, double-blind, randomized trial. The
abstract names the affiliation of the authors as "National Institute
of Neurology and Neurosurgery," which we presume refers to the
institute by that name that is located in Mexico City. According to
the abstract, in the experimental group of 11 patients who received
injections of dexamethasone, nine patients achieved "complete control
of vertigo," and the remaining two patients achieved "substantial
control of vertigo" over two years. In the control group of 11
patients who received injections of a saline solution placebo, four of
the patients achieved "complete control of vertigo," none achieved
"substantial control of vertigo," three patients achieved lesser
control of vertigo, and four patients were classified as treatment
failures and went on to receive other treatment before the end of the
two-year period. Patients in the experimental group reported
subjective improvements in the symptoms of tinnitus, aural fullness,
and hearing loss, to a greater extent than did patients in the control
group.
- Labyrinth anesthesia (lidocaine).
- From time to time, researchers will instill
lidocaine (sometimes together with the drug Kinetin) into the middle
ear (for subsequent perfusion into the inner ear) in hopes of
improving Meniere's Disease symptoms. Just how this might work
has not been satisfactorily explained (at least, not to us).
Note that this is a topic distinct from the use of lidocaine in
treating tinnitus (from Meniere's Disease or otherwise), above.
- Ototoxic drugs ("ear poisons").
- The purpose of intratympanic instillation and
perfusion of ototoxic drugs ("ear poisons") is to
chemically ablate (destroy) part or all of the inner ear.
- Streptomycin ("strep").
- The famous antibiotic streptomycin is very ototoxic,
which is one reason why it is no longer used as an antibiotic, except
in rare cases when there is no other treatment. Not only is
streptomycin toxic to the vestibule (balance function), but it is also
toxic to the cochlea (hearing function). Streptomycin may be used to
chemically ablate the balance function, but it will also destroy
whatever may be left of the hearing function, thus resulting in a
"chemical labyrinthectomy" (in effect, destruction of the entire
labyrinth). An alternative would be a
"surgical" labyrinthectomy, in which the organs of the labyrinth are
surgically removed. A high dose of gentamicin (see below) could be
used instead of streptomycin. Streptomycin may be administered
intravenously to accomplish the same result, but the destruction that
results from this procedure applies to both ears instead of one ear.
This methodology is usually used, if at all, only when the patient is
bilateral (Meniere's Disease symptoms in both ears) and has already
lost all, or nearly all, hearing in both ears.
-
Click here to search PubMed for Meniere's Disease and
streptomycin.
- Gentamicin ("gent").
- Like streptomycin (above),
gentamicin is an antibiotic, and it is
also ototoxic, although less ototoxic than streptomycin.
- There are three possible
reasons for intratympanic instillation of gentamicin.
- 1. To destroy the "dark
cells" that produce endolymph, with the objective of reducing the
production of endolymph, thus reducing the "hydrops." If this is the
reason, the hope is that the tiny hairs in the vestibule (which affect
the balance function) and the tiny hairs in the cochlea (which affect
the hearing function) will be undamaged, or at least not damaged very
much. This is usually a very low dose (in terms of volume and
strength) of gentamicin. There may be one or more injections, and the
length of time (interval) between multiple injections may vary.
- 2. To damage the tiny hairs
in the vestibule with the objective of impairing the transmission of
faulty vestibular (balance) data to the brain. If this is the reason,
the hope is that the tiny hairs in the cochlea will be undamaged, or
at least not damaged much, because damage to the tiny hairs in the
cochlea causes hearing loss. There may be one or more injections, and
the length of time between multiple injections may vary. This is
usually a somewhat higher dose of gentamicin that is given for purpose
1 above, but still a low enough dose to attempt to preserve whatever
hearing may remain.
- 3. To ablate (destroy) the
labyrinth totally, using a high dose of gentamicin, with the objective
of totally destroying the tiny hairs in the vestibule to block all
transmission of vestibular (balance) data to the brain, and accepting
the concurrent destruction of the tiny hairs in the cochlea, which
will cause deafness. This high dose of gentamicin is usually (but not
always) performed when there is little or no functional hearing left.
This is called a "chemical labyrinthectomy," because the effect is to
totally destroy all functions of the labyrinth, both vestibular and
cochlear. Streptomycin (see above) could be used for this purpose
instead of gentamicin. An alternative would be a "surgical"
labyrinthectomy, in which the organs of the labyrinth are surgically
removed.
- There are different
"protocols" for each of the methodologies above, depending on
the patient and on the doctor. The strength of the gentamicin and the
interval between the instillations may vary.
- August 25, 2005 -- A study on the use of
intratympanic gentamicin to treat Meniere's Disease has been added to
PubMed:
Long-term results of the transtympanic (intratympanic) gentamicin
treatment in Meniere's disease. The affiliation of the
authors is the Clinic of Otolaryngology in Warsaw, and the article is
in Polish. According to the abstract, nine patients were
followed for 24 months, of whom all nine achieved complete control of
vertigo, while hearing was improved in six patients, unchanged in two
patients, and profoundly lost in "only" one patient.
- Comment: We believe that "only" one out of
nine patients deafened represents a serious risk. It seems to us
that key to the outcome of intratympanic gentamicin treatment is the
protocol used: the strength of the gentamicin, the quantity
instilled, and the interval between instillations. We believe
that a good analysis of such studies can only be made having the
specific protocols at hand. We recommend that a patient considering
intratympanic gentamicin treatment ask one's doctor for the protocol
contemplated and for the studies using that protocol upon which that
doctor is relying in selecting it. (Then sit back in your chair
and watch the reaction.)
- Methodology.
- In the simplest of methods, an office procedure,
one lies on one's side, with the ear to be treated toward the sky and
the other ear against the bed or whatever surface one is lying upon.
A surgeon swabs the ear drum with a local anesthetic, then pokes a
needle through the ear drum and instills (injects with a syringe) a
drug toward the round window. [Note: the source of this
methodology is anecdotal reports from patients.] The patient
lies still for some period of time, and with luck the drug will pool
in the round window and perfuse through the round window to the inner
ear. The procedure may be repeated every week or every few weeks
for a few administrations.
- Laser.
- With this method, performed in an office, surgical
suite, or hospital, one lies on one's side, with the ear to be treated
toward the sky and the other ear against the bed or whatever surface
one is lying upon. The patient is either placed under general
anesthesia or the ear drum is swabbed with a local anesthesia.
The surgeon then uses a laser to burn a hole through the ear drum.
(Note that the laser is not used to "treat" Meniere's Disease; the
laser is merely a tool to place a hole in the eardrum.) A drug
is then instilled (injected with a syringe) toward the round window.
The patient lies still for some period of time, and with luck the drug
will pool in the round window and perfuse through the round window to
the inner ear. The patient lies for a couple of hours or so in a
recovery room in the position described above. The hole in the
eardrum heals over a couple of weeks. This method might involve
daily administration of the drug for a few days.
- Gelfoam (absorbable
gelatin sponge)
- With this method, performed in an office, surgical
suite, or hospital, one lays on one's side, with the ear to be treated
toward the sky and the other ear against the bed or whatever surface
one is lying upon. A surgeon uses a laser to burn a hole in the
ear drum. The surgeon then operates through the hole to place a
piece of Gelfoam in the bony niche that surrounds the round window.
The drug is instilled into through the opening in the ear drum and is
soaked up by the Gelfoam. The theory is that this method
provides a greater likelihood that the drug will actually be delivered
to the round window and perfused more effectively under more
consistent circumstances.
-
Abstract of Article by Dr. Silverstein, Ear Research
Foundation, Sarasota, Fla., US, concerning a procedure using
Gelfoam.
Journal of Otolaryngology-Head and Neck Surgery, May 1999.
-
Abstract of article by Dr. Arriaga, Allegheny General
Hospital, Pittsburgh, Pa., US. concerning a procedure using Gelfoam.
Laryngoscope, Nov. 1998.
-
Abstract of Article by Dr. Silverstein, Ear Research
Foundation, Sarasota, Fla., US, concerning a procedure using Gelfoam.
Ear, Nose,
and Throat Journal, Aug. 1996.
- Variation: Self-Administration
- In one variation of the procedure, reported
anecdotally by a patient, a ventilation tube (in some areas, called a
"grommet") is placed into the ear drum. This creates an opening
of some duration. Under this variation, some physicians will
have the patient self-administer the drug using a dropper, perhaps
over time.
- Silverstein MicroWick
.
- The Silverstein MicroWick was developed by
Dr. Herbert Silverstein at the Florida Ear and Sinus Center.
With this method, an air pressure ventilation tube (sometimes called
pressure equalization (PE) tube, or, in some areas, "grommet") is
placed into the eardrum. This creates an opening of some
duration. One end of the MicroWick is inserted through the tube
into the bony niche in the middle ear that surrounds the round window.
The other end of the MicroWick extends through the tube into the outer
ear. The patient may self-administer the drug over time.
-
Silverstein MicroWick page at the Florida Ear and Sinus Center,
Sarasota and Venice, Fla., US.
Great explanation of the Silverstein MicroWick, with
a great illustration! There is also a online video of the
procedure used to place the MicroWick into a patient's ear!
-
Abstract of an article by Dr. Silverstein, Ear Research
Foundation, Sarasota, Fla., US, concerning the use of a new device,
the MicroWick, to deliver medication to the inner ear.
Ear, Nose, and
Throat Journal, Aug. 1999
- Very nice
illustrations
of the Micro-Wick and of air pressure equalization (PE) tubes at the
Micromedics website.
- Round Window Microcatheter (also: Round
Window Micro-Catheter).
- The Round Window Microcatheter is a portable pump
used to deliver a consistent, controlled, quantity of
low-potency gentamicin through the ear drum to the round window
membrane separating the middle ear from the inner ear, with the
intention that the gentamicin perfuse through the round window
membrane to the inner ear. The intention is that a controlled
delivery of low-potency gentamicin over weeks would permit the
destruction of cells in the inner ear in order to reduce vertigo, yet
at the same time not be so destructive as to further impair hearing.
We first read about the round window microcatheter in
this 1997 U.S. Navy press release, which describes its use by
Navy doctors at the Naval Medical Center in San Diego. At the time,
the device was manufactured and marketed by a company called "IntraEar,
Inc." In 2001, Durect, Inc., acquired IntraEar, Inc., and the
round window microcatheter As of
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