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Medical treatment of Ménière's disease generally means care by your General Practitioner, Ear, Nose and Throat Consultant, Audiologist and other health professionals such as Hearing Therapists. It needs a team approach to be effective, and you need to be under regular review. Both of these are often not available and difficult to arrange in today's health care market. Basically you can divide medical care into:
Most help is directed to controlling acute episodes of vertigo. The aim is vertigo control with as few side effects as possible and with the minimum of long term effects. Drug treatment and general measures, such as diet and life style changes, are tried first.
Drug therapy available can be divided into two groups:
(a) Drugs aimed at controlling acute vertigo—prochlorperazine (Stemetil) and cinnarizine (Stugeron).
(b) Drugs aimed at reducing the frequency and severity of attacks betahistine (Serc) and diuretics.
Other measures are:
These measures will produce a good level of control in four out of five people, but it may not stop the episodes completely and it cannot guarantee that the episodes will not return. If these measures fail to produce satisfactory control there are other treatments that can be tried.
This involves:
These treatments, like all the previous treatments, are aimed at control of vertigo. In some circumstances they can increase tinnitus, hearing loss and balance problems. The decision to proceed with them will depend on the individual's quality of life and circumstances. Younger, employed people with responsibilities are more likely to feel that the risks are justified. Ménière's disease is a fluctuating illness, and it is usual for people to have variations in the severity of their symptoms. This can confuse decision making for both you, the patient, and your doctors. It is common for long periods of waiting and observation to precede surgery—hoping for a natural remission.
As the cause of Ménière's disease and the exact changes occurring in the inner ear are not known, there is a wealth of advice and information available about the possible effects of complementary treatments, diet, allergy, stress and exercise. Your doctor may accept anything you have found that helps your vertigo, and encourage you to continue the therapy. This can be extremely disconcerting if you are looking to your doctor for some definite authoritative medical advice!
An International Symposium on Ménière's disease was held in Paris in April 1999, and was attended by doctors from many countries including Japan, Australia. USA, Europe and the Far East. They met to discuss research, treatment and their experiences. In general, treatment in the UK is cautious, and based on the best evidence available. Concern over the long-term effects of aggressive treatment is justified. We have a comprehensive range of drugs available on the NHS and there are no new 'cures' or new treatments available.
Referral to audiologists and hearing therapists and physiotherapists depends on each person's individual problems at that time. As the disease progresses, the need to access advice about hearing loss, tinnitus and balance problems increases. Referral may be through your GP or ENT consultant. Audiological services are well organised and available throughout the UK. However, they often find helping people with MD difficult, or more correctly, challenging, and many areas do not have the financial resources to cope with fluctuating hearing loss and the sophisticated aids that may help. Once again regular review and a sympathetic well informed audiologist is valuable. A hearing therapist may be available in your area to help with adjusting to your disability and with balance problems. Again, their support and advice is invaluable. Hearing therapists, counsellors, and psychotherapists are available in some areas of the country. They can help with stress management, relaxation, anxiety and depression.