Take 2 grams a day of hydroxyethylrutosides or similar flavonoids to improve symptoms
Follow a low-salt diet to help reduce or stabilize symptoms
Avoid alcohol, nicotine, and caffeine to decrease the frequency of MD attacks
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.
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.
Lifestyle changes often recommended for MD include the elimination of caffeine, nicotine, and alcohol.2 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.3
People with MD are frequently found to have musculoskeletal disorders of the head and neck,4 including cervical spine disorders (CSD; disorders of the joints of the neck),5 and disorders of the jaw (craniomandibular disorders or CMD).6 Physical therapy to the cervical spine relieves MD-like symptoms in some cases, according to one preliminary report.7 Although spinal manipulation has been shown to reduce vertigo in preliminary human studies,8 , 9 , 10 controlled research with MD patients is lacking.
Some authorities recommend psychological counseling11 to reduce both the significant emotional distress caused by living with this disorder12 , 13 and possible stress-related MD symptoms,14 , 15 however, the benefits of counseling have not been established by controlled research. MD is not caused by psychological factors,16 and it is unclear whether stress increases the frequency or severity of attacks.17 Preliminary human studies suggest that stress increases awareness of symptoms,18 particularly vertigo.19 In a controlled human study of tinnitus, which included three participants with MD, weekly one-hour sessions of relaxation and coping techniques for ten weeks significantly reduced both tinnitus and tinnitus annoyance.20 Since very few of these participants had MD, it is not clear whether these techniques would be helpful for people with MD.
Vestibular rehabilitation exercises, used primarily to aid in recovery from vertigo, are also recommended by some authorities for MD,21 although controlled research on these exercises for MD is lacking. According to these authorities, the exercises should be started only after symptoms have been stabilized with other treatments, and should not be done during active MD. A qualified musculoskeletal healthcare specialist should be consulted.
Transcutaneous electrical nerve stimulation (TENS), a form of physiotherapy used by musculoskeletal healthcare specialists, has been reported to reduce tinnitus in people with MD in preliminary studies.22 , 23 , 24 TENS is thought to improve tinnitus by increasing circulation to the inner ear.25 In one large preliminary trial, participants with tinnitus due to various causes, including MD, received two 25- to 30-minute treatments to the ear per week for three to five weeks.26 Sixty percent of people with MD reported significant improvement of tinnitus after this treatment, and many reported a decrease in pressure in the treated ear. A controlled trial comparing the effectiveness of TENS and applied relaxation (AR; the use of an audiotape to guide the participant through a series of muscle relaxation exercises) in MD found either treatment produced similar positive results,27 but these could have been due to placebo effects. In this study, participants treated themselves with three 30-minute TENS treatments to the hand per day for two weeks, with one participant continuing treatment for three months.
Acupuncture is reported to reduce symptoms of MD in preliminary studies.28 , 29 In one trial, vertigo was eliminated after one to three treatments in a group of 34 MD patients, and measurements of hearing also improved.30 Controlled research is needed to confirm these results.
|Skip the salt||
Follow a low-salt diet to help reduce or stabilize symptoms.
A low-salt diet (no more than 800–1,000 mg sodium per day) combined with diuretic medication, is believed to reduce endolymphatic hydrops,31 and is often recommended in MD.32 , 33 , 34 While the benefits of a low salt diet and diuretics have not been scientifically proven for this condition,35 clinics specializing in MD report a significant reduction or stabilization of symptoms with this regimen.36 Preliminary human trials suggest a low-salt diet may reduce the progression of hearing loss associated with MD.37
|Try a special diet||
In one study, a low-glycemic-index diet with moderate to high protein intake, moderate to low fat, and restricted complex carbohydrates was found to reduce symptoms in patients with blood sugar abnormalities.
Some cases of MD are associated with high blood triglycerides and cholesterol, and abnormalities in blood sugar regulation, such as diabetes and hypoglycemia.38 , 39 , 40 , 41 , 42 In one preliminary study,43 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.
Work with a knowledgeable healthcare provider to see if detecting and treating allergies to airborne or food allergens might improve your symptoms.
MD is associated with allergies to airborne particles, mold, and food in some individuals, according to many preliminary reports.44 , 45 , 46 , 47 , 48 In one preliminary study, 50% of participants with MD reported known food or inhalant allergies.49 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.50 In this study, the most common food allergies were to wheat and soy. Most participants also had allergies to milk, corn, egg, and yeast.
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Refer to label instructions
Certain flavonoids, known as hydroxyethylrutosides, have been reported to improve symptoms of Ménière’s disease, including hearing problems.
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.51 Other types of flavonoids have not been studied as treatments for MD.
Some cases of MD are associated with otosclerosis,52 , 53 , 54 , 55 a disease affecting the small bones of the inner ear. Otosclerosis often goes undiagnosed in people with MD, although the coexistence is well documented.56 While preliminary reports suggest otosclerosis may be a cause of MD,57 , 58 the relationship between these two conditions remains unclear. Sodium fluoride, a mineral compound available only by prescription, is reported to improve otosclerosis.59 , 60 , 61 , 62 In a preliminary study,63 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.
Refer to label instructions
Ginkgo has been reported to reduce symptoms of tinnitus, vertigo, and hearing loss due to unspecified inner ear disorders.
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.64 Controlled research using GBE is needed to determine whether it is a treatment option specifically for MD.
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