New Treatments of Menieres Disease

New Treatments for Meniere's Disease

Timothy C. Hain, MD

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latanoprost. Rask-Andersen et al. (Otol HNS 2005, 133, 441-443). These authors report injections of this drug through the ear drum once/daily for 3 days. 9 patients were studied. They report improvements in vertigo (30%) and hearing. This drug, used for treatment of glaucoma, has been here tried in the ear. The apparent rationale is reduction of hydrops. This small study shows that it is feasible to use this drug. It is too small to say if it is truly useful.

Lupron. Price et al (Arch Otol HNS 120:209-11, 1994) reported a case where Lupron alleviated the symptoms of Menieres. Lupron is a drug which shuts down natural production of sex hormones. Our assessment at this writing is that the cost/benefit ratio of this drug is not reasonable.
Nimodipine. Lassen and others, Am J Otology 17(4):577-80, 1996. Nimodipine is a calcium channel blocker. It is mainly used for control of blood vessal spasm in patients with aneurysmal bleeding. They reported successful control or improvement of vertigo and hearing in seven of 12 patients. Our assessment of this drug is that, at least in the USA, this drug is too expensive to use routinely. However we sometimes do use a related drug in our own practice.
Isosorbide. Kanda and others (Acta Otol Vol 504, 79-81, 1993) and Nozawa and others (ORL 57:135-40, 1995) reported their experience with this drug in 32 and 30 patients, respectively. It should be understood that this is NOT isosorbide dinitrate which is commercially available in the US, but rather is an osmotic diuretic somewhat resembling glycerol. They reported successful control in 60-80%. Our assessment: we do not understand how this drug could work over the long term and these results are uncomfortably close to placebo. However, if available it may be worth a try.
Neurontin (Gabapentin). This new drug which is indicated for treatment of seizures also may be helpful in patients with vestibular disorders. No studies are available regarding this use. We have had encouraging results in patients with ongoing nystagmus.
Transtympanic steroids. Shea and Ge (Otol Clin NA, 1996, 29:353-8, also Am J Otol,18:4,1997). These authors reported positive effects from use of steroids injected into the middle ear, combined with intravenous steroids.However, a double blind study found no significant difference between dexamethasone inner ear perfusion and placebo (Silverstein H, Isaacson JE, Olds MJ, rowan PT, Rosenberg S; Am J Otol 19:2:1998, 196-201) It is our opinion as well as that of the consensus (See Blakely, Am J Otol, 18:4, 1997), that this treatment is presently investigational, and that a firm scientific basis for its use is lacking. We are particularly concerned that the positive effects, if present, are transient.
Alternobaric and hyperbaric oxygen. Fattori et al, Audiology 35(6):322-34, 1996. These authors report the results of treatment for 15 days with 90 min. sessions of a pressure chamber. They report better hearing results in the treated patients. Comment: lacking a reasonable mechanism and also considering the general problems with placebo responses in Menieres (see the classic paper entitled Old and New in Menieres, by N. Torok), this treatment remains unsubstantiated.
Treatment in general. Several authors from the Cleveland clinic (Am J Otol 18:67-73, 1997) surveyed long term hearing results and quality of life in patients with Menieres. They concluded that no statistically significant results was detected in long-term hearing in medically or surgically treated patients compared to untreated patients. Comment: this study adds more support to the general opinion that there is no effective treatment that prevents hearing loss in Menieres. However, nearly everyone agrees that treatment does influence dizziness.