MENIERE'S DISEASE: ON-GOING OR LONG-TERM TREATMENT
Diuretics
Drugs that reduce the water and salt content of the body and therefore the inner ear (diuretics) are the mainstay of on-going treatment for Meniere's disease. The thiazide group of drugs such as Chlorothiazide (cChlotride) and a drug called chlorthalidone (cHygroton) would be the most common agents used here. They have the side effect of causing a loss of potassium from the body, so potassium supplements need to be taken as well. Other diuretics that act in different ways and ones that can preserve potassium can also be used.
Vasodilators
Another long-term treatment thought to be of use in Meniere's disease is aimed at increasing the blood supply to the affected inner ear. This may reduce the excess of fluid (hydrops) in the ear and may also help the ear recover from damage done during an acute attack. Drags that have this action are called vasodilators and include Nicotinic Acid and Betahistine (cSerc). There are other drags that are thought to both suppress vertigo and improve blood supply to the ear that can be obtained only on approval from the Health Department.
Physical therapy
Acute, severe and repeated attacks of Meniere's disease will reduce the function of the inner ear, both hearing and balance. When the balance function is reduced, the ear will not respond appropriately to movement of the head. This leads to a reduced input to the central processing area of the brain that regulates our position in space and an imbalance with the correct input coming from other parts of the body.
Such an imbalance is felt by us as vertigo. This motion-induced vertigo can be helped greatly by performing a graded series of exercises that provoke it. The more the brain experiences the altered input from the affected ear the more likely it is to reset its levels and the 'imbalance' ceases, reducing or resolving the vertigo. This is called 'habituation therapy'.
Chemical ablation
When an ear continues to cause repeated and distressing attacks of Meniere's disease it may be necessary to reduce or destroy the remaining vestibular function of that ear in order to reduce or prevent vertigo. This can be done in some cases by injecting the middle ear directly with drugs such as Gentamicin and Streptomycin. These drugs are absorbed across the windows between the middle and inner ears and are toxic to the balance nerve endings. They may also reduce hearing and are reserved for cases when the hearing is already poor.
In cases where there is severe Meniere's disease in both ears, partial ablation of the balance function of both ears can be useful to reduce severe vertigo attacks. Streptomycin can be given intramuscularly in repeated doses over days or weeks whilst monitoring the effects with tests of hearing and balance function.
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GENERAL HEALTH
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