CHALLENGES AND SYMPTOM-ORIENTED TREATMENT OF MÉNIÈRE’S DISEASE
Szirmai A. Budapest, Hungary
Ménière’s disease (MD) is a disorder of the inner ear, characterized by episodic rotational vertigo, sensorineural hearing loss, tinnitus, aural pressure and vegetative symptoms, such as nausea and vomiting. The classic MD triad can we seen in only 20% of the patients. MD shows a great variability in attack’s frequency, length of attacks, hearing loss and tinnitus severity. The progression severity and the effectiveness of the therapy are also variable.
Since the improvement of these symptoms exerts influence over the patients’ quality of life and the condition seems to be incurable, the symptomatic conservative treatment suggests an important question.
The aim of the presentation is to show how we could provide periods without vertigo attacks at the tertiary referral otoneurologic centre of our clinic. According to our assumption the administration of different pharmacologic agents of the conservative treatment results significant improvement in the symptomatic condition of the patients with MD.
Betahistine, the agent widely used in Europe as a first line treatment for MD seemed to be successful in the conservative treatment of the symptoms according to our observations. 80% of our patients are attack free for a long time using betahistine alone or a betahistine combined with nootropics. Third grade MD patients became attack-free after intratympanal gentamycin treatment. Patients with constant imbalance have assisted vestibular training to improve the balance function. Hearing preservation is a difficult problem in MD, but few patients have hearing improvement using intratympanal dexametason treatment. When the hearing loss is disturbing, we can fit a hearing aid but this is a great challenge for the audiologist because of the recruitment, the aural fullness, and the Tullio phenomenon, and the small dynamic range of the ear. Anxiety disorder as a co-morbidity is often occurred in MD and can cause further deterioration in quality of life. Anxiety has to be treated together with Ménière’s disease.
In spite of there not being a gold standard in the treatment of Ménière’s disease, we can still do a lot for the control of the symptoms and for the improvement of the quality of life of MD patients. Vertigo-diary can help in the effective symptom-oriented treatment of Ménière’s disease.