Alternative Treatments for Menieres Disease

and Treatments not used in the USA but possibly effective

Last edited: 9/02. Timothy C. Hain, MD

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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 anti-oxident.
  • 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 vestibular neuritis.
  • 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 conventional treatment.
  • 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.

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