Alternative Treatments for Menieres
and Treatments not used in the USA but possibly effective
Last edited: 9/02. Timothy C.
Please read our disclaimer.
While the author of this material does not advocate or generally prescribe
most of these medications, these medications are sometimes advocated for treatment
of Menieres disease. There is a very long history of treatment of Meniere's
disease with numerous odd medications, devices and procedures (Torok, 1977).
As the natural history of the disease is for remission in 60% after 6 months,
treatments must do better than this to be better than doing nothing.
Acupuncture. Steinberger and Pansini reported that "Meniere's
disease responds very well to acupuncture treatment" (1983). These authors
also suggest that acupuncture can treat deaf-mutism. COMMENT: This claim of
good response is highly implausible. In my discussions with local acupuncturists,
they feel that they can relieve tinnitus in about 40%, or in other words, about
the same as placebo. It seems possible that acupuncture might cause a small
improvement in Meniere's however, especially if applied to the area of the ear.
In the Danish sham surgery study, patients who had tubes put in their ears did
better than the natural history of the disease. Perhaps local stimulation changes
blood flow or immunological characteristics.
Dexamethasone. Given that dexamethasone helps when given orally or
by intravenous injection, it would seem logical that it might work given as
an injection directly into the ear. At this writing (9/2001), this procedure
has not been shown to be of clear benefit. Silverstein et al (1998), found that
it had no benefit over placebo. The logical problem is that the effects would
be unlikely to persist for more than 24 hours.
Echinacea has immune enhancing effects. It is not advocated for Menieres.
To the extent that Menieres is an autoimmune condition, Echinacea might even
be a negative influence on Menieres. No studies are available.
Ginkgo Biloba. Part of the alternative medicine pharmacopia, this plant
derivative is advocated as a treatment for vertigo and tinnitus. COMMENT: Possibly
mildly effective. There is also a literature about Ginkgo for memory loss but
a recent randomized clinical trial suggested that it is not effective (Solomon
et al, 2002). Ginkgo was reviewed recently (Kanigel, 1999) where evidence is
discussed regarding use of Ginkgo for Alzheimer's disease, sexual dysfunction,
depression, headache, claudication, vertigo and tinnitus. Some patients with
tinnitus claim that it helps. Nevertheless, as of 2001, controlled studies suggested
that Ginkgo does not work for tinnitus (Drew et al, 2001). Ginkgo may reduce
the viscosity of the blood (literally blood thinning), and it may also be an
Ginkgo probably should not be taken with other blood thinners such as aspirin,
warfarin, or similar agents such as Plavix, or if it is, caution should be taken
(bleeding times should be checked), according the the article above. Ginkgo
should be stopped at least 36 hours prior to surgery. Ginkgo increases the INR
when combined with warfarin. Ginkgo may also be associated with toxicity when
combined with trazodone (a sleep medication). Ginkgo may reduce the effects
of seizure medications. Should not be taken by persons hypersensitive to poison
ivy, cashews or mangoes. Side effects also include mild GI upset.
The amount of active ingredient in herbal preparations available in the states
vary widely. It is best to look for labels that say EGb 761, which is the extract
from the leaves. In Germany, Ginkgo is regulated so products from there may
be more standardized. Most studies of Ginkgo use 120 to 240 mg/day. Some authors
suggest that 240 mg twice a day is appropriate (Seidman, 2002). The bottle should
say "24% Ginkgo flavenoids" or "24% Ginkgo glycosides" or
"50:1 standardized extract".
Histamine. Can be given as injection or drops. See considerations below
concerning Serc regarding the rationale for use. COMMENT: This medication is
generally felt to be a placebo in the US, but some physicians are convinced
of its effectiveness. Serc (see below), is a longer lasting histamine agonist.
Serc, however is not entirely equivalent to Histamine.
Lysine. A naturally occuring amino acid, lysine is popular in France
for treatment of vertigo (Rascol et al, 1995). COMMENT: Possibly useful for
Meniett machine. This is a new
device that exerts pressure through a tube placed through the ear drum. A machine,
costing about $3000 and requiring minor otologic surgery, exerts pressure pulses
that reach the round window via a tube. COMMENT: Although it is too early to
be sure, this device is probably a placebo. There is a small amount of evidence
that ventilation tubes help Meniere's (for example, the Danish Sham study).
There is a very long history of bizzare devices being used with initial enthusiasm
in Meniere's disease that initially appear promising due to the very variable
nature of the disease (see Torok's classic 1977 paper , "Old and New in
Meniere's Disease"). We suspect that this device is simply another one
of these. There are good statistical reasons to be very suspicious of any treatment
for Meniere's disease that has not been proven in a very large number of subjects.
The evidence offered on the company's web site (a 2 week trial in about 40 patients)
is not at all convincing. We think that someone considering a Meniett would
generally be better served with a proven treatment that has a clear reason to
work such as transtympanic gentamicin.
Serc. (Betahistine). The story about this drug is complex and details
can be found here. In brief, at the present writing it is not clear if it
is an effective medication, but it does not appear to be harmful. The author
of this page frequently gives it a try in patients who have not responded to
T'ai Chi. While nothing is specifically reported in Meniere's, it seems
reasonable that it might help with balance
rehabilitation, and the author of this review has had studied
T'ai Chi for this purpose. We think it is helpful.
Valerion. This plant product is generally used for sedation. COMMENT:
It may also be helpful with vertigo, as it appears similar to the benzodiazepines.
Vertigo-Heel. A homeopathic medication. COMMENT: Probably a placebo.
A recent study suggested that Vertigo-Heel was equally effective to Serc (Klein,
1998). This doesn't say much for Serc.
- Cohen AJ and Bartlik B. Ginkgo biloba for andidepressant induced sexual
dysfunction. J. Sex Marital Ther 1998;24:139-43
- Drew S, Davies E. Effectiveness of Ginkgo biloba in treating tinnitus: Double
blind, placebo controlled trial. BMJ 2001; 322: 73
- Kanigel R. Why patients take Ginkgo. Hippocrates, Oct 1999, 11-13. Hippocrates
is a magazine published by the Mass. Medical Soc.
- Klein P et al. Homeopathic vs. conventional treatment of vertigo: a randomized
double-blind controlled clinical study. Acta Otol HNS 124:879, 1998
- Le Bars PL et al. A placebo-controlled, double-blind randomized trial of
an extract of Ginkgo biloba for dementia. JAMA 1997:278:1327-32.
- Rascol O, Hain TC, Benazet M, Clanet M, Montastruc JL. Antivertigo Medications
and Drug-Induced Vertigo Drugs 50 (5) 777-791, 1995.
- Seidman. RE and Keate B.:Letter to the editor -- Myths in neurotology, revisited:
smoke and mirrors in tinnitus therapy. Otol Neurotol 23:1013-1016, 2002
- Silverstein H and others. Dexamethasone inner ear perfusion for the treatment
of Meniere's disease: A prospective, randomized double-blind crossover trial.
Am J. Otol. 19:196-201, 1998
- Solomon PR and others. Gingko for memory enhancement: a randomized controlled
trial. JAMA 2002:288:835-840
- Steinberger A, Pansini M. The treatment of Meniere's disease by acupuncture.
American J. Chinese Med, 1-4, 102-105, 1983
- Timmerman H. Histamine agonists and antagonists. Acta Otolaryngol (Stockh)
- Torok N. Old and new in Meniere's disease. Laryngoscope 1977, 85, 131-135