Timothy C. Hain, MD, Responds

No cure exists for Meniere's disease, a rare inner ear disorder that affects about one in 2,000 people and is characterized by hearing loss, tinnitus (ringing in the ears), a sensation of fullness or pressure in the ear, and episodes of dizziness or vertigo. But lifestyle changes—quitting smoking, adopting a low-salt diet, avoiding monosodium glutamate (MSG), limiting caffeine, doing balance exercises, reducing stress—and some drugs help treat symptoms and may reduce the number of future attacks.

Experts attribute Meniere's disease to excessive fluid and swelling in the inner ear. It also may be familial, with different (but as yet unknown) genes increasing the probability of developing the disease.

To make a diagnosis, doctors conduct hearing tests, assess balance, and order an MRI scan of the inner ear. They also rule out other conditions that might cause hearing loss, tinnitus, ear fullness, or vertigo, such as a brain tumor or multiple sclerosis.

No known risk factors for Meniere's have been identified, but about 50 percent of people diagnosed with it get migraine headaches. They also are more likely to have a form of dizziness called benign paroxysmal positional vertigo (BPPV)—the sudden sensation of spinning or the inside of the head spinning.

Because of the overlap between migraine and Meniere's, some doctors prescribe migraine preventive treatments such as the antiepileptic drug topiramate (Topamax) and the antidepressant nortriptyline (Pamelor), which have been shown to work for a small percentage of Meniere's patients.

Treatments for hearing loss and tinnitus associated with Meniere's are not very effective. As hearing loss progresses, which it does very slowly—over decades in most cases—hearing aids can be helpful initially. If it continues to progress, however, hearing aids are no longer effective.

To help prevent vertigo, doctors may prescribe a low-salt diet—about 1.5 grams of sodium per day (roughly a quarter of a teaspoon)—and add a diuretic drug such as hydrochlorothiazide-triamterene (Dyazide). The combination lowers the level of fluid in the ear and may reduce bouts of vertigo and slow hearing loss progression. Evidence of the effectiveness of anti-vertigo drugs such as betahistine (Serc) is weak, but doctors still prescribe them.

For people who experience BPPV, doctors may recommend something called the Epley maneuver, an exercise that helps reposition crystals of calcium in the ear that become loose and cause dizziness.

To treat acute dizzy spells, doctors usually prescribe meclizine (Verticalm), an antihistamine used for motion sickness, or lorazepam (Ativan), a benzodiazepine and sedative, possibly combined with ondansetron (Zofran), an anti-nausea drug. For severe situations, steroid treatments, either orally or as an injection into the middle ear, may improve hearing or reduce dizziness for a few months.

If the dizzy spells happen without warning or cause a fall, doctors may prescribe a low dose of gentamicin, an antibiotic administered by injection through the eardrum. This is a big advance in treating dangerous dizzy spells, replacing more drastic measures such as cutting the nerve or surgically removing the inner ear. However, because the drug can damage vestibular function and worsen hearing, it is reserved for patients with severe vertigo.

In addition to medications, vestibular rehabilitation therapy—exercises that help you adjust your vision and balance to feel less dizzy and more in control—may be effective in preventing at least some Meniere's attacks and making the ones that do occur easier to manage.