Timothy C. Hain,
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.
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.
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.
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
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).
Ginkgo Biloba. Part of the alternative medicine pharmacopia, this plant
derivative is advocated as a treatment for vertigo and tinnitus.
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
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.
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)
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.
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
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.
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.
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.
- John of Ohio
- This is a "shotgun" combination of several vitamins, food additives, herbals, and homeopathic substances costing about $1-2/day. No patients with Meniere's from my very active medical practice have commented to me one way or the other concerning the effectiveness of this regimen. Homeopathic treatments are, in general, all placebos.
- Steady Centeredness. One of my patients thinks that this works.
- It is from the Kan herb company in Scotts Valley, California, 800-543-5233. The ingredients are: gastrodia rhizome, eucommia bark, abolone shell, siler root, chinese skullcap root,gardenia fruit, gambier stem branch and twig, tribulus fruit, simple leaf chaste tree fruit, lycium fruit, Chinese dodder seed
Vertigo-heel - -see placebo web-page.
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
- Anonymous. Trimetazidine: a second look. Just a placebo. Prescrire Int. 2000 Feb;9(45):207-9
- Cohen AJ and Bartlik B. Ginkgo biloba for andidepressant induced sexual
dysfunction. J. Sex Marital Ther 1998;24:139-43
- Drew S, Davies E. Effectiveness of Ginkgo biloba in treating tinnitus: Double
blind, placebo controlled trial. BMJ 2001; 322: 73
- Kanda K, Watanabe Y, Shojaku H, Ito M and Mizukoshi K (1993). "Effects of
isosorbide in patients with Meniere's disease." Acta Otolaryngol Suppl 504:
- Kanigel R. Why patients take Ginkgo. Hippocrates, Oct 1999, 11-13. Hippocrates
is a magazine published by the Mass. Medical Soc.
- Kim HH, Wiet RJ, Battista RA. Trends in the diagnosis and the management of Meniere's disease: results of a survey.Otolaryngol Head Neck Surg. 2005 May;132(5):722-6.
- Klein P et al. Homeopathic vs. conventional treatment of vertigo: a randomized
double-blind controlled clinical study. Acta Otol HNS 124:879, 1998
- Le Bars PL et al. A placebo-controlled, double-blind randomized trial of
an extract of Ginkgo biloba for dementia. JAMA 1997:278:1327-32.
- Leong AC, Pothier DD, Rutka JA.Oral Mycostatin as a possible alternative treatment for intractable Ménière's disease: preliminary cohort study. J Laryngol Otol. 2014 Mar 19:1-2. [Epub ahead of print]
- Nelson, R. Successful treatment of immune inner ear symptoms with nystatin: Preliminary Findings. Presented at the American Neurotology Society meeting, 1993
- Nozawa I, Nakayama H, Hashimoto K, Imamura S, Hisamatu K and Murakami Y
(1995). "Efficacy of long-term administration of isosorbide for Meniere's
disease." ORL J Otorhinolaryngol Relat Spec 57(3): 135-40.
- Rascol O, Hain TC, Benazet M, Clanet M, Montastruc JL. Antivertigo Medications
and Drug-Induced Vertigo Drugs 50 (5) 777-791, 1995.
- Seidman. RE and Keate B.:Letter to the editor -- Myths in neurotology, revisited:
smoke and mirrors in tinnitus therapy. Otol Neurotol 23:1013-1016, 2002
- Silverstein H and others. Dexamethasone inner ear perfusion for the treatment
of Meniere's disease: A prospective, randomized double-blind crossover trial.
Am J. Otol. 19:196-201, 1998
- Smith WK, Sankar V, Pfleiderer AG.A national survey amongst UK otolaryngologists regarding the treatment of
Meniere's disease. Laryngol Otol. 2005 Feb;119(2):102-5
- Slattery WH, Fayad JN. Medical treatment of Meniere's disease. Otolaryngologic clinics of NA, 1997; 30, 1027-37
- Solomon PR and others. Gingko for memory enhancement: a randomized controlled
trial. JAMA 2002:288:835-840
- Steinberger A, Pansini M. The treatment of Meniere's disease by acupuncture.
American J. Chinese Med, 1-4, 102-105, 1983
- Taylor JA and others. Efficacy and safety of Echinacea in treating upper
respiratory tract infections in children. JAMA 290, 21, 2984-
- Thomsen, J., K. Sass, et al. (2005). "Local overpressure treatment reduces vestibular symptoms in patients with Meniere's disease: a clinical, randomized, multicenter, double-blind, placebo-controlled study." Otol Neurotol26(1): 68-73.
- Timmerman H. Histamine agonists and antagonists. Acta Otolaryngol (Stockh)
- Torok N. Old and new in Meniere's disease. Laryngoscope 1977, 85, 131-135
August 3, 2016
, Timothy C. Hain, M.D.
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August 3, 2016