Clinical trials
Several Cochrane reviews have been published on various treatments for Ménière's disease.
The drug betahistine hydrochloride has been used to reduce the frequency and severity of the attacks. While this drug is very acceptable to patients who use it, the review of clinical trials did not find enough evidence to show whether it is helpful.1
The authors of another systematic review on the use of diuretics carried out an extensive search but could not identify any RCTs of sufficient quality and concluded that there was no good evidence about the effect of diuretics on the symptoms of Ménière's disease.2
Conversely, chemical labyrinthectomy with gentamicin was regarded as an effective treatment for vertigo complaints in Ménière's disease, but carried a risk of increasing hearing loss. 3
Despite an extensive search the review authors only found two RCTs studying surgical interventions for Ménière's disease.4 The two trials included in the review on surgical treatments for Ménière's disease concluded that there was insufficient evidence of the beneficial effect of endolymphatic sac surgery.
Guidelines
There is no uniformly accepted evidence-based treatment protocol given the pathophysiology of Ménière's disease.
Other factors responsible for the lack of a uniform treatment protocol include the fluctuating nature of this disease, with spontaneous, potentially long-term remissions, the frequent but poorly understood overlap with conditions such as migraine, and the high placebo effect of treatment. As such, no guidelines on Ménière's disease are available from NICE or SIGN.
Curriculum
This topic is covered in the GP curriculum in statement 15.4: ENT and facial problems
More online
This summary helps patients understand Ménière's disease.
Surgical procedures for selected patients with Ménière's disease.
- Ménière's Society www.menieres.org.uk/
- Detailed description of Cawthorne-Cooksey vestibular rehabilitation exercises. www.entkent.com/Cawthorne-Cooksey.html
References
1. James A, Burton MJ. Betahistine for Ménière's disease or syndrome. Cochrane Database Syst Rev 2001, Issue 1. Art No CD001873. DOI: 10.1002/14651858.CD001873.
2. Burgess A, Kundu S. Diuretics for Ménière's disease or syndrome. Cochrane Database Syst Rev 2006, Issue 3. Art No CD003599. DOI: 10.1002/14651858.CD003599.pub2.
3. Pullens B, van Benthem PP. Intratympanic gentamicin for Ménière's disease or syndrome. Cochrane Database Syst Rev 2011, Issue 3. Art No CD008234. DOI: 10.1002/14651858.CD008234.pub2.
4. Pullens B, Giard JL, Verschuur HP et al. Surgery for Ménière's disease. Cochrane Database Syst Rev 2010, Issue 1. Art No CD005395. DOI: 10.1002/14651858.CD005395.pub2.
Contributed by Mr Samuel Leong, specialist registrar in otorhinolaryngology - head and neck surgery, University Hospital Aintree, Liverpool
