--- title: "Meniere's Disease Part 3 - Medical Management" description: "ENT notes on Medical Management of Meniere's Disease." source: "The ENT Resident" author: "Dr. Mausumi Das" canonical_url: "https://www.theentresident.com/ent-notes-lectures/menieres-disease-medical-management-chemical-labyrinthectomy-meniett" categories: ["Otology"] video: "https://www.youtube.com/watch?v=71f-WU8ipKk" image: "https://media.theentresident.com/og-images/menieres-disease-medical-management-chemical-labyrinthectomy-meniett.png" --- # Meniere's Disease Part 3 - Medical Management ENT notes on Medical Management of Meniere's Disease. Watch the full video lecture on YouTube: https://www.youtube.com/watch?v=71f-WU8ipKk ## 👂 Meniere's Disease - Medical Management Treatment of Meniere's disease is divided into four broad categories: 1️⃣ General measures 2️⃣ Medical management 3️⃣ Transtympanic and intratympanic therapies 4️⃣ [Surgical management](https://www.theentresident.com/ent-notes-lectures/menieres-disease-surgical-management-endolymphatic-sac-decompression.md) This post covers the **first three categories**. --- ### 📋 General Measures **1- Reassurance** ⭐ The patient's anxiety is very high because of the symptoms they experience. The nature of the disease, what to expect, why it happens and how the symptoms will be treated must be explained. ⭐ Particularly helpful during the **acute phase of an attack**, when vertigo can be very debilitating. **2- Salt Restriction** 👉 Salt intake should not exceed **1.5 to 2 grams per day** **3- Cessation of Smoking** ⭐ Must be **completely stopped**, as **nicotine causes vasospasm**, which worsens the disease. **4- Other Advice** * Avoid excessive intake of water * Avoid excessive coffee, tea and alcohol * Avoid stress * Mental relaxation exercises and yoga * **Bed rest** during an acute attack --- ### 💊 Medical Management Three groups of drugs are used: 1️⃣ Vestibular sedatives 2️⃣ Diuretics 3️⃣ Vasodilators --- #### 1- Vestibular Sedatives 👉 Purpose: **To relieve vertigo** ⭐ Administered **intravenously or intramuscularly** only when **vomiting precludes oral administration**. > Name the common Vestibular Sedatives used in Meniere's disease and mention their dosages as well. > Which vestibular sedative is preferred when the patient has vertigo along with anxiety? --- #### 2- Diuretics ⭐ **First line drugs** in Meniere's disease. **Drugs Used** * Hydrochlorothiazide * Acetazolamide * Hydrochlorothiazide with triamterene > What is the Mechanism of Action of diuretics in Meniere's disease? > Which diuretic is used during an acute attack of Meniere's disease? --- #### 3- Vasodilators **A- Betahistine** ⭐ The more commonly used vasodilator. An **analogue of histamine**, with: * **Weak H1 agonistic** property * **Potent H3 antagonist** property > What is the Mechanism of Action of Betahistine in the treatment of Meniere's disease? > What is the Dose of Betahistine used in the treatment of Meniere's disease? **B- Carbogen Inhalation** * A very good **cerebral vasodilator** * Inhalation **improves labyrinthine circulation** > What is the composition of Carbogen? --- ### 💉 Transtympanic & Intratympanic Therapies 1️⃣ Meniett device (Transtympanic low pressure therapy) 2️⃣ Intratympanic injection of corticosteroids 3️⃣ Intratympanic injection of gentamicin --- #### 1- Meniett Device (Transtympanic Low Pressure Therapy) ⭐ The patient can **self-administer** the treatment at home. > What is the Indication of Meniett Device in the treatment of Meniere's disease? **🧠 Mechanism of Action** Delivery of **intermittent positive pressure to the inner ear fluids**. **Prerequisite** 👉 **[Myringotomy with insertion of a grommet (ventilation tube)](https://www.theentresident.com/ent-notes-lectures/myringotomy-grommet-insertion.md)** > What is the Pathway of the Pressure Waves in Meniett device? **Symptoms Relieved** * Vertigo * Tinnitus * Fullness in the ear ⭐ Hearing may also improve. > What is the dose of usage of Meniett Device in treatment of Meniere's disease? --- #### 2- Intratympanic Injection of Corticosteroids **📌 Indication** Patients who have failed a combination of **dietary restrictions and medical therapy** with vasodilators and diuretics for **6 months**. > What is the Mechanism of Action of Corticosteroids in treatment of Meniere's disease? **Drugs Used** * Dexamethasone * Methylprednisolone > What are the Methods of Administration of Corticosteroids in treatment of Meniere's disease? --- #### 3- Intratympanic Injection of Gentamicin #### 📌 Also Known As 👉 **Partial Chemical Labyrinthectomy** ⭐ Gentamicin is an ototoxic drug, but has **greater vestibular toxicity relative to cochlear toxicity**. 👉 This helps control the **vestibular symptoms** while **sparing hearing**. > What are the Indications of Intratympanic Injection of Gentamicin in treatment of Meniere's disease? > What is the Mechanism of Action of Intratympanic Injection of Gentamicin in treatment of Meniere's disease? **Administration** Same pathways as for intratympanic corticosteroids. **Dose** * **40 mg/ml**, diluted with lidocaine or sodium bicarbonate buffer to make **30 mg/ml** * **Weekly injections** **Outcome** ✅ Total control of vertigo in **60 to 80%** of cases ⚠️ The patient may develop **imbalance** or **visual vestibular mismatch**. > What are the Complications of Intratympanic Gentamicin therapy? > What is Acute Vestibular Deafferentation Syndrome? --- ### 🧠 Viva Pearls * Treatment of Meniere's disease is divided into general measures, medical management, transtympanic and intratympanic therapies, and surgical management. * Salt intake is restricted to 1.5 to 2 grams per day. * Smoking must be stopped completely, as nicotine causes vasospasm. * Vestibular sedatives are used to relieve vertigo. * Diuretics are the first line drugs, and act by reducing endolymphatic volume and pressure. * Betahistine is an analogue of histamine, with weak H1 agonistic and potent H3 antagonist properties. * Betahistine reduces the frequency and intensity of vertigo, with minimal effect on tinnitus. * The Meniett device delivers intermittent positive pressure and requires a grommet in place. * Intratympanic gentamicin is also known as partial chemical labyrinthectomy. * Gentamicin has greater vestibular than cochlear toxicity, so hearing is spared. * Intratympanic gentamicin gives total control of vertigo in 60 to 80% of cases. --- ## About This Note This free ENT note on Meniere's Disease Part 3 - Medical Management was written by Dr. Mausumi Das and is paired with a corresponding video lecture. 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