Meniere's Disease: What It Is and Treatment Options

If you've ever felt like the room was spinning, your ears were ringing and your balance was playing a joke on you, you might have experienced a glimpse of what it's like to live with Meniere's disease.

Here, we look at what treatments are available to help alleviate Meniere's disease symptoms and prevent attacks, as well as what costs to expect from them.

What Is Meniere's Disease?

Meniere's disease is a problem that affects your inner ear and can lead to debilitating bouts of nausea, dizziness, vertigo, a feeling of fullness in the ear, ringing in the ears (tinnitus) and hearing loss. Not only are these attacks somewhat unpredictable, but they can negatively affect your quality of life.

Named for the French physician Prosper Ménière, who discovered it in 1861, Meniere's disease affects around 0.2% of the population in the United States, or about 615,000 people. It mainly affects those between 40 and 60 years old, with around 45,500 new cases emerging each year. It has no cure.¹

Medications to Treat Meniere's Disease

Before trying more invasive treatments, your doctor will likely prescribe one or more medications to help alleviate the symptoms of your Meniere's disease attacks and help prevent the attacks from occurring.

Anti-nausea medications

One of the main side effects of Meniere's disease is nausea, which can result in vomiting. To help combat this, your doctor may prescribe an anti-nausea medication such as promethazine or scopolamine to treat these symptoms during attacks.

• Promethazine is a type of antihistamine that is also used to treat nausea. Possible side effects include drowsiness, dizziness, headaches and nightmares.
• Scopolamine is administered with a transdermal patch that you wear for up to 72 hours (three days). Side effects include blurred vision, dilated pupils, dry mouth and agitation.
• Promethazine costs around $14.36 for a 30-tablet supply of 25-milligram pills.
• Scopolamine costs around $30.59 per four-pack of patches.

Diuretics

Diuretics are medications that help rid your body of excess fluid buildup, which may help reduce the amount of fluid (endolymph) that is overproduced in your inner ear. The most commonly prescribed diuretics for Meniere's disease are Dyazide (hydrochlorothiazide and triamterene) and Diamox (acetazolamide).

• These medications may help prevent or lessen the severity of attacks of vertigo due to Meniere's disease, and your doctor will prescribe them for long-term use. They may help stabilize your hearing as well.
• Dyazide is a combination medication that helps prevent fluid buildup in the body. Common side effects include dizziness, upset stomach, changes in your appetite and headache.
• Diamox blocks the activity of carbonic anhydrase, a type of protein that can contribute to fluid buildup in the body. Common side effects include tinnitus, fatigue, nausea, vomiting, abdominal pain, tingling in the arms and legs (paresthesia) and an altered sense of taste.
• Dyazide costs around $20.28 for 90 capsules. Diamox averages around $45.20 to $84.74 for 100 250-milligram tablets.

Steroids

For those dealing with a Meniere's disease attack, your doctor may prescribe a steroid medication, such as prednisone, for a week.

• Steroids help reduce inflammation caused by the disease during an attack but have serious systemic side effects.
• Potential side effects of prednisone use include weight gain, blurred vision, depression, hypertension, insomnia, mood changes, osteoporosis and slow healing.
• Prednisone averages around $10.15 for 10 20-milligram tablets.

Antihistamines

Typically available over the counter, antihistamines like meclizine are commonly recommended by doctors to treat the vertigo caused by Meniere's disease. These medications are typically used to combat nausea and vertigo due to motion sickness.

• Meclizine is available in chewable or tablet form.
• Meclizine won't prevent attacks but will help with symptoms of Meniere's disease.
• The most common side effects of meclizine are drowsiness, dry mouth, headache and vomiting.
• The cost of meclizine is around $13.35 for 30 25-milligram tablets.

Benzodiazepines

Benzodiazepines like diazepam and lorazepam also treat symptoms of vertigo and may control motion sickness, anxiety and depression during a Meniere's disease attack.

• They attach to gamma-aminobutyric acid type A (GABAA) receptors in the brain to produce a sedating effect.
• These medications can lead to withdrawal if stopped suddenly.
• Common side effects of benzodiazepines include confusion, headache, diarrhea, drowsiness, dizziness and problems with balance.
• The price for lorazepam is around $15.34 for 30 half-milligram tablets.
• Diazepam costs around $11.42 for 30 5-milligram tablets.

Antidepressants for mental health

Due to the debilitating symptoms of Meniere's disease that happen during attacks, depression occurs in around 50% of patients.² If you are dealing with depression, your doctor may recommend an antidepressant in addition to medications that control your symptoms:

• Antidepressants include selective serotonin reuptake inhibitors (SSRIs), monoamine oxidase inhibitors (MAOIs), serotonin and norepinephrine reuptake inhibitors (SNRIs) and tricyclic drugs.
• Prices range from $5 to $140 for a 30-day supply of a generic antidepressant. Brand-name antidepressants cost anywhere from $235 to $2,000 for a month's supply.

Surgical Interventions for Meniere's Disease

When your Meniere's disease attacks become very serious and medications aren't helping, your doctor might recommend surgical intervention to help alleviate your symptoms.

Endolymphatic sac decompression surgery

During this surgery, your doctor inserts a small tube into the endolymphatic sac of the inner ear to drain the buildup of excess fluid:

• This surgery is typically performed in an outpatient center.
• You'll be put under general anesthesia during this procedure.
• It can help control vertigo and stop hearing loss in patients with Meniere's disease.
• As with any surgery, a positive outcome is not 100% guaranteed. There is a chance that your attacks of vertigo will actually get worse after the procedure.
• There is also a chance that any hearing loss you have may worsen after this procedure.
• Costs for inner ear surgery range from $1,500 to $6,000.

Vestibular nerve section

To help with vertigo, during vestibular nerve section surgery, your doctor will cut the vestibular part of the cochleovestibular cranial nerve:

• This surgery is only used for patients who don't have hearing loss in the affected ear.
• Surgery involves cutting into the dura matter of the brain, retracting the cerebellum and cutting into the vestibular nerve fibers. The doctor leaves cochlear fibers untouched.
• Your doctor will perform this surgery in a hospital and you'll need to spend time in the intensive care unit (ICU) after surgery, followed by a few days in a regular hospital room.
• After surgery, you'll experience severe vertigo and loss of balance but will eventually return to normal. Some patients may need vestibular and balance therapy.
• Complications of surgery include pain, headache, tinnitus, hearing loss, facial nerve injury, meningitis and spinal fluid leak.
• Surgery on the cranial nerve may cost around $1,380 or more.

Labyrinthectomy

If you experience severe vertigo during your Meniere's disease attacks and have almost complete hearing loss in your affected ear, your doctor might recommend a labyrinthectomy:

• During surgery, your doctor removes the entire labyrinth of the inner ear, leaving the cochlea intact.
• This surgery is a type of mastoidectomy. During the procedure, part of the inner ear is removed with a drill.
• Hearing is completely lost in the ear with this surgery, but vertigo is typically improved.
• Your doctor may perform this surgery in the hospital, which requires a hospital stay of one to three days.
• You'll require a cane or walker during recovery and possibly vestibular and balance therapy.
• Side effects include infections, facial nerve injuries and problems with balance.
• Surgery costs around $3,557 or more.

Chemical perfusion of the inner ear

One of the least invasive surgical treatments for Meniere's disease is the targeted injection of medication into the middle ear that will later reach the inner ear. These medications include dexamethasone and gentamicin:

• Gentamicin is an antibiotic that when injected into the inner ear keeps it from working. After injection, this medication stops the balance nerve endings from causing vertigo. It helps more than 90% of patients.
• Dexamethasone is a steroid medication that reduces inflammation when injected into the inner ear. It may help improve your Meniere's symptoms.
• Your doctor will inject either medication directly into the middle ear, behind the eardrum.
• With perfusion of the inner ear with either gentamicin or dexamethasone, there is the potential result of hearing loss. Other complications include persistent dizziness or imbalance, worsened tinnitus, infection and a hole in the eardrum.
• Costs for injectable steroid treatments are around $500.

Non-Surgical Treatment Options for Meniere's Disease

In addition to medications and surgical options, there are several non-surgical treatments recommended for Meniere's disease and its symptoms.

Vestibular rehabilitation therapy (VRT)

Vestibular rehabilitation therapy is a specialized form of physical therapy for people dealing with Meniere's disease symptoms, including dizziness, vertigo and balance issues. This therapy helps retrain your brain to control Meniere's symptoms:

• During sessions, your physical therapist will give you exercises to help improve symptoms of vertigo, dizziness and problems with balance.
• Therapy occurs on an outpatient basis, or in the hospital in some cases.
• Sessions are performed by a licensed physical or occupational therapist.
• Exercises may worsen your symptoms initially but will help in the long run.
• Your therapist may recommend balance, postural, gaze stabilization and spine range of motion exercises as part of your assessment and treatment.
• Therapy lasts until your symptoms improve, and you can continue to do exercises at home to maintain your progress.
• Sessions typically cost between $75 and $150 and may be covered by health insurance.

Low-sodium diet

To prevent water retention, your doctor may recommend a low-sodium diet for you:

• Eating less than 2,000 milligrams of sodium each day should be your goal.
• Those with severe symptoms should aim for 1,500 milligrams of sodium per day.
• Keep track of your sodium intake by not adding salt to food, avoiding prepared foods and reading food labels.
• The cost of a low-sodium diet may be more expensive up front than your current one if you are used to eating prepackaged and prepared foods. However, if you are eating a primarily home-cooked diet rich in fruits, vegetables and whole grains, you may not notice much of a difference.

Stress management and self-care techniques

While excess sodium can lead to Meniere's disease attacks, stress and anxiety can also bring on an attack. To deal with stress and help with the depression that may accompany Meniere's disease, utilize stress management techniques and self-care. Stay calm and avoid or lessen the effects of an attack through:

• Yoga
• Meditation
• Tai chi
• Mindfulness exercises like guided imagery

Classes in yoga, meditation, tai chi and mindfulness generally cost around $60 to $80 per session. But you can also find free videos online to follow.

Acupuncture therapy

Acupuncture is a form of traditional Chinese medicine that involves the insertion of fine, sterilized needles into the skin. The treatments can help you feel relaxed, relieve pain, boost immunity and improve blood flow.

Treatments can also help relieve symptoms of a Meniere's disease attack, including tinnitus, hearing loss and dizziness.

• Look for practitioners who use the warm-promotion needling method and specialize in treatments that target inner ear disorders.
• You may need around four sessions, spaced one day apart, to help with your symptoms.
• Sessions usually last between 60 and 90 minutes and cost between $35 and $85 each. Some insurance plans may cover your sessions.

Chiropractic care

A form of holistic medicine, chiropractic care involves the manipulation of your joints and soft tissues, known as "adjustments." While chiropractic care is usually associated with treating back pain, it may help with Meniere's disease, too.

During sessions, your chiropractor will perform adjustments on your back and neck:

• Chiropractic adjustments help correct the flow of spinal fluid. This can relieve the buildup of fluid in the inner ear, alleviating symptoms like dizziness and vertigo.
• Adjustments may improve nervous system communication. Meniere's disease affects the communication of nerves that control balance, posture and coordination, and your chiropractor's adjustments may help improve that communication to alleviate your symptoms.
• Each chiropractic session may cost between $30 and $300, depending on what treatments your chiropractor recommends.

Assistive Devices and Lifestyle Modifications

People with Meniere's disease may also want to consider assistive devices and/or lifestyle modifications that can help with symptoms and attacks.

Hearing aids

Hearing loss typically occurs intermittently in the ear(s) affected by Meniere's disease, but over time it can become permanent. That's why a hearing aid may help.

• Hearing aids can help patients with tinnitus, balance issues and spatial localization.
• Those with Meniere's disease need a hearing aid that is adjustable, as your hearing loss can change over time, or even during an attack.
• Hearing aids range in price from around $99 to $10,000 per pair.

Tinnitus-masking devices

Is tinnitus the main symptom of your Meniere's disease attacks? Then sound maskers may be the answer you are looking for:

• Tinnitus-masking devices produce a narrowband or broadband noise, also known as white noise, that helps drown out the ringing sound of your tinnitus.
• Special hearing aids include tinnitus maskers that you can use throughout the day to help with your tinnitus, unlike a typical white noise machine or app that is only used for nighttime sleeping.
• You wear tinnitus-masking hearing aids behind your ears, with a tube within the ear canal. This allows all sounds to pass through, while also masking the tinnitus.
• If you don't have hearing loss, you can turn off the amplification function of the hearing aid and still enjoy its tinnitus-masking capability.
• These tinnitus-masking hearing aids cost between $400 and $10,000 per aid.

Lifestyle modifications

In addition to eating a low-sodium diet and taking steps to decrease the amount of stress in your life, your doctor may recommend making the following lifestyle modifications to help lessen the severity and frequency of your Meniere's disease attacks:

• Stop smoking, because it can trigger an attack.
• Reduce the amount of alcohol you drink.
• Limit the amount of caffeine you ingest, which can cause vertigo.

Holistic Approaches and Complementary Therapies

In addition to traditional medicine, you may find that certain herbal remedies can help with your Meniere's disease symptoms. Before trying any herbal remedies, always consult with your physician.

Herbal supplements can cost upwards of $1 per dose, depending on where you purchase them and their ingredients. Some herbal supplements that could help with Meniere's disease symptoms include:

Ginkgo biloba

When paired with balance training, one study showed that ginkgo biloba can help with vertigo and dizziness.

Ginger

Ginger may help reduce symptoms of nausea by around 40% when given at 1 gram to 1.5 grams per day.

Dandelion root

Dandelion root acts as a natural diuretic, which may help with the fluid balance in your inner ear.

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Expert Reviewer

Cynthia Olsen, Au.D., CCC-A

Cynthia (Cindy) Olsen is a certified clinical audiologist with more than 30 years of experience. As the owner of the Audiology and Hearing Aid Center in Boise, Idaho, she specializes in hearing disorders and audiology. Cindy has worked in hospitals, physician offices and in private practice. She is foremost a clinician, but also a speaker, consultant and community volunteer.

Author Bio

Susan Paretts is a freelance writer with 19 years of experience covering health and wellness, pet care and more. Her work has been published by the American Kennel Club, Bayer Animal Health, Elanco, LIVESTRONG.com, The San Francisco Chronicle, Chewy and more.