Medical therapy is directed at treating the underlying disorder and controlling the symptoms. The primary method of treating the underlying hydrops is to implement a low-sodium diet and diuretics to reduce fluid retention and, as a result, inner ear fluid pressure. A variety of vestibular suppressants, ranging from antihistamines to benzodiazepines, are utilized to control patients’ acute symptoms. Some patients are well controlled on medical therapy and require no surgical intervention.

With the intervention intratympanic steroids, a steroid solution is placed directly into the middle ear, allowing for passive perfusion into the inner ear via the round window. Intratympanic steroids are often offered to patients with episodic vertigo, sensorineural hearing loss, and other classic symptoms of Ménière’s disease that do not respond well to medical management. Many patients often prefer intratympanic steroids on a frequent basis as opposed to taking daily diuretics and/or sedating vestibular suppressed intermittently. Intratympanic steroids are associated with fewer side effects than systemic steroids.

The Meniett Device was approved by the FDA in 1999 and requires a tympanostomy tube to be placed in the ear drum. A self-administered pressure device, the Meniett is inserted into the ear canal and applies intermittent, alternating air pressure pulses to the middle ear in order to reduce fluid pressure causing dizziness. While having early promise as a conservative treatment option, it is now used less and less frequently due to other treatment modalities.

Endolymphatic sac surgery is done in the operating room under general anesthesia and is classified as a conservative procedure because it retains the function of the inner ear. By decompressing the endolymphatic sac, there is a chance to decompress the functional component of the inner ear, reducing symptoms. The success rate is around 80% according to “Endolymphatic Sac Surgery for Ménière's Disease – Current Opinion and Literature Review,” published in International Archives of Otorhinolaryngology in 2017.

Another option is intratympanic gentamicin. Gentamicin is an antibiotic with a known side effect of hearing loss and a capacity to destroy the vestibular system. It is delivered specifically to the middle ear with the intent to reduce the function of the vestibular system in that ear. It is titrated so hearing can be preserved while vestibular function is reduced or eliminated.

A vestibular nerve section requires surgically opening the skull. The balance portion of the 8th (auditory-vestibular) nerve is cut, sparing the hearing portion. This procedure is performed less due to the advent of transtympanic steroids and gentamicin therapy. Terri L. Rocco, whose story was highlighted in the Spring 2017 issue of Hearing Health magazine, underwent this surgery. Read more about Terri.

Labyrinthectomy is the surgical removal of the inner ear and is definitive in eliminating vestibular (inner ear) function. It remains a standard for treating Ménière’s disease patients with poor hearing but is generally only used after other treatment options have failed.