Ménière’s disease (MD) is a disorder of the inner ear causing episodes of dizziness (vertigo); ringing, buzzing, roaring, whistling, or hissing sounds in the ears (tinnitus); fluctuating levels of hearing loss; and a sensation of fullness in the ear.
Head trauma and syphilis can cause MD, although in most cases the cause is unknown.
What are the symptoms of Ménière’s disease?
People with Ménière’s disease may have vertigo that may be associated with nausea and vomiting. Symptoms may also include a recurrent feeling of fullness or pressure in the affected ear and hearing difficulty. People with Ménière’s disease may also have tinnitus, which may be intermittent or continuous. The symptoms of MD are associated with an underlying condition referred to as endolymphatic hydrops, an excess accumulation of the fluid of the inner ear.1 When people have only one of the symptoms associated with Ménière’s disease, such as tinnitus or vertigo, the condition is not usually considered MD.
Medical treatments for ménière’s disease
Over the counter antihistamines, such as dimenhydrinate (Dramamine®), meclizine (Bonine®), and cyclizine (Marezine®), might be useful to treat dizziness.
Prescription anticholinergic drugs, such as scopolamine (Transderm-Scop®), prochlorperazine (Compazine®), and trimethobenzamide (Tigan®), and sedatives such as diazepam (Valium®), lorazepam (Ativan®), and alprazolam (Xanax®), are often used to treat symptoms associated with Ménière’s.
People frequently affected by disabling vertigo might require a surgical treatment (vestibular neurectomy or labyrinthectomy). Some people might benefit from a tinnitus masker, which is a hearing device that produces a sound that is more tolerable than the ringing in the ears. Healthcare providers may also suggest the use of earplugs in the presence of loud noises to prevent damage to the ear.
Dietary changes that may be helpful for ménière’s disease
A low-salt diet (no more than 800–1,000 mg sodium per day) combined with diuretic medication, is believed to reduce endolymphatic hydrops,2 and is often recommended in MD.3 4 5 While the benefits of a low salt diet and diuretics have not been scientifically proven for this condition,6 clinics specializing in MD report a significant reduction or stabilization of symptoms with this regimen.7 Preliminary human trials suggest a low-salt diet may reduce the progression of hearing loss associated with MD.8
MD is associated with allergies to airborne particles, mold, and food in some individuals, according to many preliminary reports.9 10 11 12 13 In one preliminary study, 50% of participants with MD reported known food or inhalant allergies.14 In a controlled study, participants with MD who underwent allergy treatment, including avoiding foods suspected of provoking allergic reactions, reported statistically significant improvement in tinnitus, vertigo, and hearing.15 In this study, the most common food allergies were to wheat and soy. Most participants also had allergies to milk, corn, egg, and yeast.
Some cases of MD are associated with high blood triglycerides and cholesterol, and abnormalities in blood sugar regulation, such as diabetes and hypoglycemia.16 17 18 19 20 In one preliminary study,21 a modified hypoglycemia diet with moderate to high intake of protein, moderate to low intake of fat, and restricted intake of complex carbohydrates was found to reduce MD symptoms in a large number of patients with blood sugar abnormalities. Participants with high cholesterol were put on low cholesterol diets, and those that were overweight were put on calorie-restricted diets. In addition, refined carbohydrates, alcohol, and caffeine were prohibited, and small frequent meals with between meal snacks were recommended. A majority of participants were also given supplements of calcium, fluoride, and vitamin D as described below, so the importance of these dietary changes to the overall effectiveness of the program cannot be determined. This intriguing report needs confirmation from controlled trials.
Lifestyle changes that may be helpful for ménière’s disease
Lifestyle changes often recommended for MD include the elimination of caffeine, nicotine, and alcohol.22 Although not scientifically proven, intake of these substances is believed to increase the frequency of MD attacks. In animal studies, both alcohol and caffeine have been reported to impair mechanisms in the inner ear that assist in maintaining balance.23
Nutritional supplements that may be helpful for ménière’s disease
Certain flavonoids, known as hydroxyethylrutosides (HR), have been reported to improve symptoms of MD in one double-blind study. In this study, 2 grams per day of HR for three months resulted in either stabilization of or improvement in hearing.24 Other types of flavonoids have not been studied as treatments for MD.
Some cases of MD are associated with otosclerosis,25 26 27 28 a disease affecting the small bones of the inner ear. Otosclerosis often goes undiagnosed in people with MD, although the coexistence is well documented.29 While preliminary reports suggest otosclerosis may be a cause of MD,30 31 the relationship between these two conditions remains unclear. Sodium fluoride, a mineral compound available only by prescription, is reported to improve otosclerosis.32 33 34 35 In a preliminary study,36 people with MD and otosclerosis were given supplements of 50 mg of sodium fluoride, 200 mg calcium carbonate, and a multiple vitamin supplying 400–800 IU of vitamin D per day, for periods ranging from six months to over five years. Many participants also had blood sugar abnormalities, and were asked to follow a modified hypoglycemia diet as described above. Significant improvement in vertigo was reported within six months, but improvements in hearing required one to two years. Because most participants used both diet and supplements, the importance of fluoride, calcium, and/or vitamin D to the overall results of this trial is unclear.
Are there any side effects or interactions with ménière’s disease?
Refer to the individual supplement for information about any side effects or interactions.
Herbs that may be helpful for ménière’s disease
Although Ginkgo biloba extract (GBE) has not been studied specifically for its effects in MD, in preliminary studies it has been reported to reduce symptoms of tinnitus, vertigo, and hearing loss due to unspecified inner ear disorders.37 Controlled research using GBE is needed to determine whether it is a treatment option specifically for MD.