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Diuretics for the treatment of Ménière's disease or syndrome

Diuretics (drugs which reduce fluid accumulation in the body) are commonly used in the management of the symptoms of vertigo, hearing loss, tinnitus or aural fullness in patients with Ménière's disease. 'Endolymphatic hydrops' is an increase in the pressure of the fluids in the chambers of the inner ear and is thought to be the underlying cause of Ménière's disease. Diuretics are believed to work by reducing the volume (and therefore also the pressure) of these fluids. The authors of this systematic review carried out an extensive search but could not identify any randomised controlled trials of sufficient quality to include in the review. There is no good evidence about the effect of diuretics on the symptoms of Ménière's disease and further research is needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Surgery for Ménière's disease

Ménière's disease is characterised by recurrent attacks of three major symptoms: vertigo (rotational dizziness), deafness and tinnitus (ringing of the ears), and/or aural fullness, all of which are discontinuous and variable in intensity. The symptoms of Ménière's disease are thought to be caused by excess pressure in the fluids of the inner ear which leads to sudden attacks of vertigo and hearing loss. A number of surgical procedures, of varying levels of invasiveness, have been developed to reduce the symptoms of Ménière's disease, but it is not clear whether or not these are effective. The surgical interventions can be categorised as two types: one type of surgical intervention aims to affect the natural history of the disease, with conservation of vestibular function. The other type aims to relieve symptoms by abolishing vestibular function. Both types of surgical intervention are considered in this review. Despite an extensive search the review authors only found two randomised controlled trials studying surgical interventions for Ménière's disease. Both of these trials, involving a total of 59 patients, studied endolymphatic sac surgery; one comparing it to placebo surgery and the other to a different type of surgery. Neither trial detected a significant difference between the treatment and control group.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Betahistine for Ménière's disease or syndrome

Ménière's disease is a disorder of the inner ear which results in a spinning form of dizziness (vertigo), hearing loss and ringing in the ear (tinnitus), and can be disabling. It has no known cause. When it is secondary to a known inner ear disorder, it is called Ménière's syndrome. Both can be difficult to diagnose. The drug betahistine hydrochloride (Serc®, Betaserc®) has been used to reduce the frequency and severity of the attacks. While the drug is very acceptable to those who use it, the review of trials did not find enough evidence to show whether it is helpful. Further research is needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Intratympanic steroids for Ménière's disease or syndrome

Ménière's disease is a disorder of the inner ear which results in a spinning form of dizziness (vertigo), hearing loss and ringing in the ear (tinnitus); this can be very disabling. The cause of Ménière's disease is unknown. There has been some support in the medical literature for a course of treatment that involves the injection of steroids through the eardrum and into the middle ear to reduce the frequency and severity of these symptoms.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Intratympanic gentamicin for Ménière's disease or syndrome

Ménière's disease is characterised by three major symptoms: rotational dizziness (vertigo), hearing loss and ringing in the ears (tinnitus), sometimes accompanied by aural fullness. Intratympanic gentamicin is a relatively new therapy with promising results. Gentamicin is an antibiotic which damages the inner ear and the balance organ when it is applied behind the ear drum. This treatment may decrease the spells of vertigo in Ménière's disease. In this review we assess the effectiveness of this kind of treatment for Ménière's disease. Two randomised controlled trials, including a total of 50 patients, were identified which fulfilled the review inclusion criteria. Both of these found a beneficial effect of intratympanic gentamicin therapy for Ménière's disease, although the size of the effect differed between the two trials. Based on these findings, we conclude that intratympanic gentamicin may be an effective treatment for vertigo complaints in Ménière's disease, but it carries a risk of increasing hearing loss. Further research is needed to clarify the effect of intratympanic gentamicin on vertigo in Ménière's disease and the risk of inducing or increasing hearing loss.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Positive pressure therapy for Ménière's disease or syndrome

Ménière's disease is a disorder of the inner ear, which results in vertigo, hearing loss and tinnitus. When it is secondary to another known inner ear disorder, it is called Ménière's syndrome. A number of different treatments have been used for patients with this disease, ranging from dietary measures (e.g. a low‐salt diet) and medication (e.g. betahistine or diuretics) to extensive surgery. However, Ménière's disease has a fluctuating natural course with remissions and exacerbations, which makes the evaluation of treatments difficult.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Tinnitus: Overview

Most people experience ringing in their ears every now and then, for instance after a loud concert. But some people constantly hear sounds such as a whistling noise for no apparent reason. Tinnitus can seriously affect your everyday life. Read what has been shown to help – and what hasn't.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: October 20, 2016

Vestibular rehabilitation to improve dizziness, balance and mobility in patients with unilateral peripheral vestibular dysfunction

People with vestibular problems often experience dizziness and trouble with vision, balance or mobility. The vestibular disorders that are called unilateral and peripheral (UPVD) are those that affect one side of the vestibular system (unilateral) and only the portion of the system that is outside of the brain (peripheral ‐ part of the inner ear). Examples of these disorders include benign paroxysmal positional vertigo (BPPV), vestibular neuritis, labyrinthitis, one‐sided Ménière's disease or vestibular problems following surgical procedures such as labyrinthectomy or removal of an acoustic neuroma. Vestibular rehabilitation for these disorders is becoming increasingly used and involves various movement‐based regimes. Components of vestibular rehabilitation may involve learning to bring on the symptoms to 'desensitise' the vestibular system, learning to co‐ordinate eye and head movements, improving balance and walking skills, and learning about the condition and how to cope or become more active.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

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