Guidelines
Management
Conservative Management / Self-Care Advice
Counsel the patient that:
- Ménière’s disease is a long-term condition, and vertigo usually significantly improves with treatment
- Acute attacks of vertigo usually settle within 24 hours
Advise the patient to:
- Keep their medication readily accessible
- Consider risks before undertaking activities such as driving, swimming, operating dangerous machinery, using ladders or scaffolding
Symptomatic Management – Acute Attacks
1st line: short course (up to 7 days) of oral
- ProchlorperazineTypically classified as a typical antipsychotic, but it is most commonly used for its anti-emetic and anti-vertigo effects MoA: D2 receptor antagonist, or
- Antihistamine (e.g. cyclizine, promethazine, cinnarizine)
For rapid relief of severe symptoms:
- Buccal prochlorperazine, or
- IM prochlorperazine / cyclizine
Prevention of Recurrent Attacks
1st line: Consider betahistine
- A histamine analogue (H3 antagonist + partial H1 agonist)
- MoA: increases inner ear microcirculation and reduces endolymphatic pressure
2nd line (not responding well to betahistine): refer to ENT for alternative secondary care interventions Including: diuretics, intratympanic gentamicin or corticosteroids, external pressure devices, endolymphatic shunts or sac surgery, labyrinthectomy or vestibular nerve section.
Note that vestibular rehabilitation has NO role in Meniere’s disease, it is not helpful to prevent attacks.
However, vestibular rehabilitation is useful in the other 3 most common peripheral vestibular disorders (BPPV, vestibular neuritis, labyrinthitis).
However, betahistine only has a role in Meniere’s disease, not the other 3.