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Alternative Treatments for Menieres Disease

Timothy C. Hain, MD

Page last modified: March 22, 2014

Also see the main Meniere's page for standard treatments, and the page on Meniere's treatments that are even more likely to be placebo's than these.

While the author of this material does not advocate or generally prescribe most of these medications, these medications are sometimes used for treatment of Menieres disease. There is a very long history of treatment of Meniere's disease with numerous odd medications, devices and procedures (Torok, 1977). As the natural history of the disease is for remission in 60% after 6 months, treatments must do better than this to be better than doing nothing.

  • Acupuncture.
  • Steinberger and Pansini reported that "Meniere's disease responds very well to acupuncture treatment" (1983). These authors also suggest that acupuncture can treat deaf-mutism. COMMENT: This claim of good response is highly implausible. In my discussions with local acupuncturists, they feel that they can relieve tinnitus in about 40%, or in other words, about the same as placebo. It seems possible that acupuncture might cause a small improvement in Meniere's however, especially if applied to the area of the ear. In the Danish sham surgery study, patients who had tubes put in their ears did better than the natural history of the disease. Perhaps local stimulation changes blood flow or immunological characteristics.

  • Betahistine -- see "Serc" below and on it's own page.
  • Dexamethasone. See Meniere's-placebo web page for full discusion.We occasionally recommend this treatment.
  • Echinacea, AKA purple coneflower root, has immune enhancing effects.
  • It is most often used in an attempt to prevent the common cold. It may stimulate release of TNF, interleukin-1 and interferion-beta 2. It is not advocated for Menieres. To the extent that Menieres is an autoimmune condition, Echinacea might even be a negative influence on Menieres. No studies are available. Anti-TNF agents (such as Enbrel) are used to treat autoimmune inner ear disease -- Echinacea does the opposite. It would also be irrational to use Echinacea with immunosuppressants and especially with Enbrel. Echinacea preparations vary greatly. Echinacea was recently reported ineffective in treating upper respiratory infections (Taylor et al, 2003).

  • Ephedra. This is a herbal product (ma huang) used for weight loss and performance enhancement. It contains ephedrine and pseudoephedrine. Non-herbal forms of these drugs are used as decongestants. Ephedra accounts for 64% of all adverse herbal reactions. We see no reason to use this drug in Meniere's disease.
    Ginkgo Biloba. Part of the alternative medicine pharmacopia, this plant derivative is advocated as a treatment for vertigo and tinnitus.
  • COMMENT: Possibly mildly effective. There is also a literature about Ginkgo for memory loss but a recent randomized clinical trial suggested that it is not effective (Solomon et al, 2002). Ginkgo was reviewed recently (Kanigel, 1999) where evidence is discussed regarding use of Ginkgo for Alzheimer's disease, sexual dysfunction, depression, headache, claudication, vertigo and tinnitus. Some patients with tinnitus claim that it helps. Nevertheless, as of 2001, controlled studies suggested that Ginkgo does not work for tinnitus (Drew et al, 2001). Ginkgo may reduce the viscosity of the blood (literally blood thinning), and it may also be an anti-oxident.

    Ginkgo probably should not be taken with other blood thinners such as aspirin, warfarin, or similar agents such as Plavix, or if it is, caution should be taken (bleeding times should be checked), according the the article above. Ginkgo should be stopped at least 36 hours prior to surgery. Ginkgo increases the INR when combined with warfarin. Ginkgo may also be associated with toxicity when combined with trazodone (a sleep medication). Ginkgo may reduce the effects of seizure medications. Should not be taken by persons hypersensitive to poison ivy, cashews or mangoes. Side effects also include mild GI upset.

    The amount of active ingredient in herbal preparations available in the United States vary widely. It is best to look for labels that say EGb 761, which is the extract from the leaves. In Germany, Ginkgo is regulated so products from there may be more standardized. Most studies of Ginkgo use 120 to 240 mg/day. Some authors suggest that 240 mg twice a day is appropriate (Seidman, 2002). The bottle should say "24% Ginkgo flavenoids" or "24% Ginkgo glycosides" or "50:1 standardized extract".

    Ginseng. Advocated for vitality. Systematic reviews show no benefit for cognitive function, physical or psychomotor performance, immunomodulation, diabetes, or herpes simplex-II. We see no role for Ginseng in Menieres disease.

    Histamine.

    Can be given as injection or drops. See considerations below concerning Serc regarding the rationale for use. COMMENT: This medication is generally felt to be a placebo in the US, but some physicians are convinced of its effectiveness. Serc (see below), is a longer lasting histamine agonist, widely used in some countries for Meniere's (e.g. UK). Serc, however is not entirely equivalent to Histamine.

  • Isosorbide. Kanda and others (Acta Otol Vol 504, 79-81, 1993) and Nozawa and others (ORL 57:135-40, 1995) reported their experience with this drug in 32 and 30 patients, respectively. Comment should be understood that this is NOT isosorbide dinitrate which is commercially available in the US, but rather is an osmotic diuretic somewhat resembling glycerol. They reported successful control in 60-80%. Our assessment: we do not understand how this drug could work over the long term and these results are uncomfortably close to placebo. However, if available it may be worth a try.
  • John of Ohio. This is a "shotgun" combination of several vitamins, food additives, herbals, and homeopathic substances costing about $1-2/day. See below under "shotgun" for more comments.
  • Kava. This herbal preparation is used for anxiety and insomnia. It's action seems to be a GABA agonist and possibly a mild 5-HT 1A action. It may be effective for anxiety. Long term safety is unkown. Possible adverse reactions include headache, dizziness, dermatitis, and severe liver injury. There likely also is a withdrawal syndrome. We do not advise use of Kava.
  • Lipoflavonoids. (updated 8/1/2009)
  • This preparation mainly contains a mysterious substance (lemon bioflavonoids derived from lemons) and and vitamin C (300 mg). In addition to the two main ingrediants it includes choline, inositol, as well as tiny quantities of several other vitamins. We do not know of any reason why any of these ingrediants should affect Meniere's disease. According to the manufacturor, who quote Dr. Slattery (2007), it may affect "microcirculation". There is one uncontrolled study by Williams, quoted by Dr. Slattery and Fayad, that reported a "beneficial effect". COMMENT: We see no harm in this product. It seems unlikely that it is anything more than a placebo. We have encountered many patients who take this product for a few months. We have encountered very few who take it longer than this.

    More can be found here: lipoflavonoids

    Lysine. A naturally occuring amino acid, lysine is popular in France for treatment of vertigo (Rascol et al, 1995). COMMENT: Possibly useful for vestibular neuritis.

  • Manganese. An internet search turns up numerous pages that suggest that Maganaese (in trace amounts) is helpful for Meniere's disease. A search of pubmed for "Manganese Menieres") turns up -0- peer reviewed papers on the same subject. At this writing (8/2003), it appears that Manganese is another placebo treatment of Meniere's.
  • Meniett machine. We have recently moved the discussion of this device to the Menieres placebo web page. We do not recommend it in our practice.
  • Nimodipine. Lassen and others, Am J Otology 17(4):577-80, 1996. Comment: Nimodipine is a calcium channel blocker. It is mainly used for control of blood vessal spasm in patients with aneurysmal bleeding. They reported successful control or improvement of vertigo and hearing in seven of 12 patients. Our assessment of this drug is that, at least in the USA, this drug is too expensive to use routinely. However we sometimes do use a related drug in our own practice.
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  • Mycostatin (Nystatin). As recently as 2014 (Leong et al), this antifungal was suggested to be effective for intractable Meniere's disease. It was also suggested to be helpful by Nelson, in a conference paper concerning autoimmune inner ear disease (1993). Evidence for it working on either condition is weak, and we do not understand the rationale either. The dose of Nystatin as used for Meniere's treatment is 100,000 units, 3 to 4 times/day. This is similar to the regimen used for treatment of oral candida -- also called Thrush (a fungus). The suspension contains 100,000 units/cc. Nystatin is poorly absorbed in the gut and most passes through to the stool. Thus it would seem that any effect would necessarily be through alteration of gut flora, presumably by reducing the number of fungi.
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  • Serc. (Betahistine).
  • The story about this drug is complex and details can be found here. In brief, at the present writing it is not clear if it is an effective medication, but it does not appear to be harmful. The author of this page frequently gives it a try in patients who have not responded to conventional treatment. Some patients respond extremely well. A recent survey reported that 94% of the ENT surgeons in the United Kingdom prescribe betahistine to their Meniere's patients (Smith et al, 2005)

    Shotgun regimens for Meniere's. A shotgun regimen consists of a large # of substances mixed together and sold as a nutritional supplement for Meniere's disease. These sorts of approaches are usually placebos. On the other hand, they are an efficient way to try out a large number of ingrediants. Also, whatever works is OK with us.

  • T'ai Chi. While nothing is specifically reported in Meniere's, it seems reasonable that it might help with balance rehabilitation, and the author of this review has had studied T'ai Chi for this purpose. We think it is helpful. We offer a DVD containing our study protocol (from 1993).
  • Trimetazidine. This is a drug designed for heart disease, that is marketed in Europe for vertigo and tinnitus. It's brand name is Vasterel. The author of this page has had no experience with this medication for Meniere's. Some authors indicate that it is a placebo. (anon, 2000)
  • Valerion. This plant product (garden heliotrope, vandal root) is generally used for sedation.
  • Adverse effects are similar to benzodiazepines (i.e. valium type drugs). There may also be a withdrawall syndrome. Hepatotoxicity is possible with long term use. COMMENT: It may also be helpful with vertigo, as it appears similar to the benzodiazepines (Valium like drugs). We think it is unreasonable to choose Valerion, which has variable quality and possible contaminants, over conventional treatment with benzodiazepines.

  • Vertigo-heel - -see placebo web-page.
  • References:

    Copyright August 3, 2016 , Timothy C. Hain, M.D. All rights reserved. Last saved on August 3, 2016