First Line Treatment of Meniere’s Disease

Abstract

Introduction: There is no consensus on the first line medical treatment of Meniere disease to produce symptomatic improvement and slow the disease progress. Dietary salt restriction, diuretics, and vasodilators like betahistine are among the first line drugs that have been used for long. There is lack of evidence due to paucity of quality studies to support their effectiveness and advocate their use. This study is done to evaluate the effectiveness of three first line treatment of Meniere disease i.e. salt restriction, oral diuretics, and betahistine.
 
 Methods: Double blind randomized controlled trial was carried out in out-patient clinic of Ear Nose and Throat department of Lumbini Medical College Teaching Hospital. Cases were randomized into three groups; dietary salt restriction, diuretics as amiloride and furosemide, and vasodilator as betahistine. Pre and post treatment evaluation was done in terms of number and severity of vertigo, tinnitus, and hearing outcome.
 
 Results: There were a total of 97 cases with F:M ratio of 1.1:1. Mean age of patients was 47.86 yr (SD=12.7). Twenty-nine (30%) were treated with dietary sodium restriction alone (Group A), 35 (36%) were treated with diuretics (Group B) and the rest 33 (34%) were treated with vasodilator (betahistine, Group C). There was no significant difference in hearing outcome in any group. Tinnitus was significantly improved in Group B. Number of vertigo attack was significantly decreased in Group B and Group C. Severity of vertigo was significantly decreased in Group B.
 
 Conclusion: Dietary salt restriction alone was not effective in controlling any aspect of the disease whereas diuretics were effective in reducing tinnitus and number and severity of vertigo. Betahistine was effective in reducing the number of vertigo attacks but not effective on other aspects of the disease.

Clinical Practice Guideline: Ménière’s Disease

“…There were no RCTs or SRs to support that these dietary restrictions prevent MD attacks. As such, they categorized both as “unknown effectiveness.” One identified RCT 210 found no evidence that dietary sodium restriction was effective in controlling symptoms of MD. However, the number of subjects was small, and there is no indication that subjects were given any information or counseling regarding sodium and diet.…”

Pharmacologic and surgical therapies for patients with Meniere’s disease: a protocol for a systematic review and meta-analysis

“…We will include primary studies that meet the following criteria: Population. Studies enrolling adult patients with MD per established criteria (i.e., American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) [9]) receiving pharmacologic or surgical interventions for their condition (e.g., endolymphatic sac decompression, intra-tympanic gentamicin injection, or others as detailed below) will be sought [15]. In studies with enrollment criteria that required patients to be unresponsive to a prior intervention in order to be treated with the intervention(s) of interest, we will discuss the potential for important clinical heterogeneity with our clinical experts and exercise discretion about whether these studies can be appropriately combined together in quantitative analyses.Interventions/comparators .…”

Lifestyle and dietary interventions for Ménière’s disease

“…A clinical practice guideline, Basura 2020, identified one RCT that compared salt restriction to medical therapies for Ménière's disease (Acharya 2017), but as no placebo arm was included in this study it has not been included in our review.…”