Meniere's Disease: treatments that may be placebos

Timothy C. Hain, MD • Page last modified: April 3, 2023

It is best to be skeptical about new treatments for Meniere's.

Because Meniere's disease fluctuates, very large numbers are needed to prove that a treatment is effective. In other words, one can easily by chance have a sequence of patients who do well on any particular medication or device, which is actually a placebo. Considerable data supporting this idea has been put forth by Torok (1977) and Ruckenstein (Ruckenstein et al. 1991).   Torok (1977) reviewed an immense number of bizarre devices.   We are fortunate to live in a country with considerable ingenuity, but although more bizarre devices have been developed since then, so far, there is no magic bullet for Meniere's.

Here is the bottom line --

• There is very little evidence that any currently available treatment, whether it be medical or surgical, changes hearing in Meniere's disease.
• There are no devices that are anything more than minimally effective for treatment of Meniere's.
• There is extremely good evidence that certain destructive treatments (such as low dose intratympanic gentamicin) alleviate dizziness. See the main Meniere's page for our suggestions how to proceed with a staged treatment algorithm.   

So, the rational approach to Meniere's is to confirm your diagnosis, exhaust the medical treatment, and if things are really bad, go on to a destructive treatment (especially low-dose gentamicin).

Here are the details:

Betahistine -- slightly effective ?

A full discussion is under the link. We recommend a try of betahistine in Meniere's because the risk/benefit ratio is reasonable, mainly because the risk is negligable.

Cocculus.

This is a homeopathic remedy, and therefore it is almost certainly a placebo. It is advocated for Meniere's disease, and nearly any ear condition. As a placebo, it has no side effects.

Ear-vite plus.

This is a multivitamin preparation.  The literature documents that it contains small amounts of various vitamins and lemon extract.  The pamphlet presents no evidence or data that it works.  It is marketed by the same group that markets "all natural ear wax removal system" (active ingredient -- olive oil).

Ebselen (SPI-1005) -- "a proprietary formulation of the organoselenium compound ebselen, with potential anti-oxidant, anti-inflammatory and cytoprotective activity"

This is a new player on the block, from "Sound Pharmaceuticals". This information comes from a soundpharma news release, dated 6/25/2019.

According to the news release, this drug (ebselen), an antioxidant, was associated with improvement in hearing (on average) in a study of 147 Meniere's patients. The improvement was defined as >= 10 db improvement from baseline at "one low frequency", as well as improvement in word recognition. This trial was lead by Dr. Lambert, a neurotologist from USC. SP-1005 is being tested in Meniere's, noise induced hearing loss, and both aminoglycoside and chemotherapy ototoxicity. This company has it's scientific director Dr. Kil. Dr. Kil has been working on this compound since 2004, which is encouraging. (Kil, 2007; Lynch, 2004) Right now, there is too little data on this trial to comment. If this drug can revive dead neurons (such as in aminoglycoside ototoxicity), it will indeed be a miraculous agent. Unfortunately, usually endeavors aiming to bring the dead back to life fail. Also unfortunately, large multicenter trials like this one seem to be difficult to manage and often result overly enthusiastic reports that are disproven in subsequent follow-up studies(e.g. Meniett trial, see below). All things considered, perhaps this compound (an anti-oxidant) might mitigate damage to the ear from a variety of sources. In Meniere's, it seems possible that it might slow down deterioration. More to come on this page once there is more data.

Endolymphatic Shunt -- slightly effective ?

The endolymphatic shunt is used by some doctors hoping to relieve pressure in the inner ear. It involves opening up the endolymphatic sac, with the thought that this may reduce pressure in the inner ear. Generally, opening up the sac also does damage to the sac, so this procedure may actually just be a method of damaging the sac. A discussion of shunt surgery is found here.

Similar to shunt surgery is endolymphatic sac decompression surgery. This is a process where an ear surgeon drills bone around the area of the sac in the mastoid bone. Again, we advise against this surgical procedure.

We do not presently recommend any shunt or decompression procedure for our Meniere's patients except in very unusual situations. These may include a person who has perfectly normal hearing, or an older person who might not tolerate the gentamicin procedure described above (Pensak and Friedman, 1998; Gianoli et al, 1998).

Endolymphatic duct blockages --

Basically the opposite of a shunt. This is discussed here. This procedure is unproven at this date (2022).

Sac ablations ?

Another surgery hat runs completely opposite to the logic of the shunt is to purposefully damage the sac -- crushing it, drilling it out, drilling around the sac, or putting clips on it. As the sac is the immune organ of the ear, damaging the sac makes a some sense if one is attempting to immunosuppress the ear.

More about shunt surgery can be found here.

Hyperbaric oxygen.

Fattori et al, Audiology 35(6):322-34, 1996. These authors report the results of treatment for 15 days with 90 min. sessions of a pressure chamber. They report better hearing results in the treated patients. Comment: lacking a reasonable mechanism and also considering the general problems with placebo responses in Menieres (see the classic paper entitled Old and New in Menieres, by N. Torok), this treatment remains unsubstantiated.

NAC. n-acetyl cysteine

Strangely enough, treatment with an antioxidant, NAC, is reported to improve hearing after noise exposure. Thus we have here duelling placebos -- an oxidant (hyperbaric oxygen), and an antioxidant (NAC).

Intratympanic steroids -- promising

We have recently moved this discussion into the main Meniere's page, as it seems now to be a "emergent" treatment rather than a placebo. We find it hard to follow the logic of using a drug that is gone in a few days, to treat a chronic illness. Nevertheless, there is a reasonable literature to support this endeavor.

Labyrinth anesthesia -- Placebo ?

(Adunka, Moustaklis et al. 2003) In this treatment, lidocaine and Kinetin are instilled into the middle ear using transtympanic injection. A remission was reported in 66% of patients. It is difficult to see why a local anesthetic that is gone in hours at most should cause a long lasting remission. Kinetin is a plant growth factor, pesticide, and an ingredient in skin preparations. Perhaps Kinetin has a positive effect on Meniere's disease.

Latanoprost -- slightly effective research treatment ?

Latanoprost. Rask-Andersen et al . (Otol HNS 2005, 133, 441-443). These authors from Sweden report injections of this drug through the ear drum once/daily for 3 days. 9 patients were studied. They report improvements in vertigo (30%) and hearing. This drug, used for treatment of glaucoma, has been here tried in the ear. The apparent rationale is reduction of hydrops. This small study shows that it is feasible to use this drug. It is too small to say if it is truly useful. It is difficult to see how one would administer this drug chronically. Still, there is some promise here.

Lupron -- effective for a linked disorder (migraine) ?

Price et al (Arch Otol HNS 120:209-11, 1994) reported a single case where Lupron alleviated the symptoms of Meniere's. Comment: Lupron is a drug which shuts down natural production of sex hormones. Our assessment at this writing is that the cost/benefit ratio of this drug is not reasonable.

Meniett -- evidence says it is a placebo

This device, developed in Sweden, and sold in the US by Medtronics, incorporates a ventilation tube and pulsed pressure to the ear using a device that appears rather similar to an aquarium pump. The Meniett costs $3500 -- roughly 100 times as much as an aquarium pump. It is reported to reduce attacks by roughly a factor of two. We have not observed this effect in patients that we have followed.  According to a recent systemic review that included 18 studies (Ahsan et al, 2014), there was "a trend toward improvement". This is not a factor of two.

A similar device to the Meniett is the "MeniQ" (see above). It appears to be a smaller battery powered version of the Meniett, from material on their website.

A systemic review of the Meniett device (Syed et al, 2015) stated that "No evidence was found to justify the use of the Meniett device in Meniere's syndrome/disease." A Cochrane review (von Sonsbeek et al, 2015) similarly concluded that " There is no evidence, from five included studies, to show that positive pressure therapy is effective for the symptoms of Meniere's disease. " Russo et al (2016) found no difference between Meniett patients and Placebo. Devantier et al (2019) stated that "The current available evidence does not support positive pressure device treatment in patients with Menière's disease. "

To be fair, there are some positive papers concerning similar devices. Nakazato et al (2022) wrote "MEPT with the EFET01 significantly improved vertigo in the first period, with further improvement in the second period. The efficacy and safety were comparable to MEPT with other devices." ... ", an MEPT device developed in Japan and covered by national health insurance since September 2018". Hm.

The method is to have a ventilation tube put into the symptomatic ear, and then to apply pulsed pressure 5 times/day using a pump as shown on the upper left.  The MeniQ omits the ventilation tube. As the methodology with a PE tube is a placebo, we would not think that it matters much if the tube is left out.

It is claimed to improve Meniere's disease by means of altering endolymphatic pressure. It is difficult to comprehend why pulsed pressure should be beneficial. Some have suggested that this device "milks endolymph through the endolymphatic valve".  We are just not familiar with the anatomic location of the "endolymphatic valve" (see this page for more about the anatomy).  Nevertheless, the Meniett (not MeniQ) might be effective in people who actually have a perilymphatic fistula and who are misdiagnosed as Meniere's disease. In this case, we would think that the "active effect" is from the ventilation tube rather than the Meniett pump. We think that those who are dead-set on using this device should consider just having the tube put in first, and seeing how they do, prior to purchasing the Meniett.

Cost: Surgery is required to use this device to put in a tube, and the Meniett device itself is expensive (about $3500). As noted above, recent studies suggest that the Meniett is a placebo. According to the manufacturers web site (see link), less than 100 patients have been used in studies which suggest its effectiveness. An industry funded study by Gates et al (2004) suggested that the device is helpful (based on 66 more patients). However, there are some potential problems with the study in that it may not be possible to "blind" people to use of an active device. It is also difficult to see any reason why this device might work, especially considering contemporary theories of the etiology of Meniere's. Fortunately, one can get a refund of the $3500 price of the Meniett device itself if it is ineffective (at 6 weeks).

Bottom line: At this writing (early 2018), we advise avoiding this type of device. It might be considered just prior to going on to a last resort destructive treatment (but we wouldn't suggest doing it). Less than 10% of practicing otologists routinely recommend this device (Kim et al, 2005). We do not recommend this device in our practice in Chicago. We are NOT recommending use of an aquarium pump for Meniere's either! (:

Neurontin in Meniere's disease-- modestly effective for a linked disorder (? migraine ?)

(Gabapentin). Comment: This drug which is indicated for treatment and pain also may be helpful in patients with vestibular disorders. No studies are available regarding this use. We have had encouraging results in patients with ongoing nystagmus.

NingXia Red

This is a berry extract sold by "Young Living", containing "essential oils". One of my patients had a a substantial hearing improvement, associated in time with using this product. We ourselves have no opinion at all about this product's utility in Meniere's.

Oatmeal -- Salovum and SPC-Flakes (Antisecretory factor)

SPC-Flakes are a variety of oatmeal, rolled oats, advocated for Meniere's disease. The idea that oatmeal might improve Meniere's is of course, implausible, and logically one would be wondering if this was a statistical problem as plagues most studies of Meniere's (e.g. Torok, 1977; Ruckenstein et al, 2001). There have been a whole series of underpowered (i.e. too few patients) studies of this oatmeal product. This commercial product was initially based on a study done in 1998 at a Swedish Hospital, which is not accessible through Pubmed. Hanner et al (2010), another Swedish group, studied 51 patients, and reported decreased vertigo in about half. Hanner and associates have published 3 positive studies regarding this product. Leong et al (2013) in 39 patients, suggested that more than half of patients reported subjective improvement. A more recent tiny study based in Denmark of 32 patients suggested that it was a placebo. (Ingvardsen and Klokker, 2015). These studies are small and as they deal with an expensive commercial product, bias could be a problem.

At this writing, early 2016, it appears to us that the jury is still out on oatmeal treatment for Meniere's. Our guess is that it is a placebo given that the studies are underpowered. Meniere's is not uncommon -- in the author's practice, as of 2018, we have more than 1026 patients in our database. One would think that a larger study would not be so difficult. At some point, a Cochrane review process might be in order.

Section of middle ear muscles. -- placebo ?

It has been reported that section of middle ear muscles is useful in Meniere's disease (Franz et al, 2003). The rationale for this procedure is difficult to follow, and we would like to see more studies before recommending this procedure. It may be another placebo treatment.

T-bio.

This is another multi-ingrediant preparation, that seems aimed mainly at dizziness and nausea. It has two main active ingredients -- dimenhydrinate (dramamine), and ginger root. As of 2/2011, they sold 60 tablets for $14. We can easily find better deals on the web.   These components are also available in drugstores under their ordinary names.

Treatment of any kind for Meniere's

Treatment in general. Several authors from the Cleveland clinic (Am J Otol 18:67-73, 1997) surveyed long term hearing results and quality of life in patients with Meniere's. They concluded that no statistically significant results was detected in long-term hearing in medically or surgically treated patients compared to untreated patients. Comment: this study adds more support to the general opinion that there is no effective treatment that prevents hearing loss in Meniere's. However, nearly everyone agrees that treatment does influence dizziness.

Vascular disorders.

In a dramatic and misleading article, Anu Passary, a writer for "Tech Times", put an article online titled "Cure for Meniere's disease discovered ?" Dramatic and unfortunately, very misleading.

Here Anu Passary interviewed Dr. Carol Foster, an otolaryngologist at U. Colorado, suggesting that Meniere's was linked to migraine. More about Dr. Foster's work is here Somehow Anu turned this into "cure for Meniere's". While it probably pulls in clicks, unfortunately, this is just wrong. It is well known that Meniere's and Migraine are linked -- from papers going back far before Dr. Foster's work. It is irresponsible journalism to suggest that an association between two illnesses is somehow the same as a "Cure for Meniere's disease".

Ventilation tubes -- effective for a difficult to exclude rare alternative diagnosis, PLF ?

There is a mixed literature about implantation of ventilation tubes for Meniere's disease. It may be another placebo treatment, but it is easily done, and generally harmless too (see "last resort" section). Eustachian tube malfunction does not appear to generally modulate Meniere's disease (Maier et al, 1997).

Vertigo-Heel -- harmless placebo.

A homeopathic medication. A variant of cocculus, almost certainly a placebo. A study suggested that Vertigo-Heel was equally effective to betahistine (Serc) (Klein, 1998). This doesn't say much for Serc.

Vestibular Prosthesis (pacemaker)

In 2010, Dr. Jay Rubinstein at the University of Washington implanted a "vestibular prosthesis" in a human being, with the idea that when the vestibular nerve is temporarily shut down during a Meniere's attack, the patient can turn on the prosthesis to stimulate the nerve until the inner ear recovers (in a few hours).  Thus, during the attack, one would have one inner ear that is disabled, and another that is still working (responding to head motion).  This would be an improvement over the natural situation where the neural activity in one ear is disrupting function of the entire balance system.

Lets look at the logic of this device. The goal is to block vertigo for a few hours by returning the vestibular nerve function on one side to baseline. There are very substantial practical problems involving in matching the adjusting the output of the stimulator, both in amplitude and vector. Even if it were to work perfectly, the individual with Meniere's would still be working with half of their vestibular function -- not enough we would think for most people to walk or drive.   The input to the ear from the prosthesis, very likely not perfect in amplitude or direction, may cause an unnatural input that could be very disturbing.  In other words -- this device can't "fix" Meniere's due to very substantial engineering challenges.

The risks and costs of this device are substantial -- surgery to implant the device with all the associated medical risks, and the cost of the device itself. Overall, we think that there are very few people for whom this device might be helpful, but it will be interesting to see what emerges from this trial.

Zinc. -- placebo.

This element has also been suggested as being helpful for vertigo. There are no references on this in Pubmed. Most feel that Zinc is a placebo when used to treat Meniere's disease.

Zyvestra -- placebo

This homeopathic medication is almost certainly a placebo, supplied as a cream and as a pill. Homeopathic preparations are nearly always placebos due to their nature involving very high dilutions.

More -- on this page, we have more commentary about devices for dizziness (not necessarily Meniere's).

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References:

• Adunka, O., E. Moustaklis, et al. (2003). "Labyrinth Anesthesia - A Forgotten but Practical Treatment Option in Meniere's Disease." ORL J Otorhinolaryngol Relat Spec 65(2): 84-90.
• Ahsan SF1, Standring R, Wang Y.Systematic review and meta-analysis of Meniett therapy for Meniere's disease.Laryngoscope. 2014 Jun 10. doi: 10.1002/lary.24773.
• Bretlau P, J Thomsen, M Tos and NJ Johnsen (1982). "Placebo effect in surgery for Meniere's disease. A double-blind placebo-controlled study on endolymphatic sac shunt surgery." Adv Otorhinolaryngol 28: 139-46.
• Bretlau P, J Thomsen, M Tos and NJ Johnsen (1984). "Placebo effect in surgery for Meniere's disease: a three-year follow-up study of patients in a double blind placebo controlled study on endolymphatic sac shunt surgery." Am J Otol 5(6): 558-61.
• Bretlau P, J Thomsen, M Tos and NJ Johnsen (1989). "Placebo effect in surgery for Meniere's disease: nine-year follow-up." Am J Otol 10(4): 259-61.
• Devantier L, Guldfred FL, Djurhuus BD, Händel MN Schmidt JH Hougaard DD, Edemann-Callesen H. Eur Arch Otorhinolaryngol.Positive pressure device treatment for Menière's disease: an overview of the current evidence and a meta-analysis. 2019 Feb 27. doi: 10.1007/s00405-019-05359-y. [Epub ahead of print]
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• Hargunani and others. Intratympanic injection of dexamethoasone: time course of inner ear distrubution and conversion to its active form. Otol Neurotol 27:564-569, 2006
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• Nakazato A, Takakura H, Ueda N, Do TA, Takeda N, Watanabe Y, Shojaku H. 12-month effect of middle ear pressure therapy with the EFET01 device for intractable definite Meniere's disease and delayed endolymphatic hydrops after certification by the public health insurance system in Japan. Acta Otolaryngol. 2022 Jun 20:1-8.
• Rask-Andersen et al. Effects of intratympanic injection of latanoprost in Meniere's disease: a randomized placebo-controlled, double-blind, pilot study. Otol HNS 2005, 133, 441-443
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• Russo FY1,2,3, Nguyen Y1,2, De Seta D1,2,3, Bouccara D1,2, Sterkers O1,2, Ferrary E1,2, Bernardeschi D1,2. Meniett device in meniere disease: Randomized, double-blind, placebo-controlled multicenter trial. Laryngoscope. 2016 Aug 12. doi: 10.1002/lary.26197.
• Thomsen J, P Bretlau, M Tos and NJ Johnsen (1983). "Meniere's disease: a 3-year follow-up of patients in a double-blind placebo-controlled study on endolymphatic sac shunt surgery." Adv Otorhinolaryngol 30: 350-4.
• 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 Neurotol 26(1): 68-73.
• Silverstein H, Isaacson JE, Olds MJ, Rowan PT, Rosenberg S; Am J Otol 19:2:1998, 196-201
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• van Sonsbeek, S., et al. (2015). "Positive pressure therapy for Meniere's disease or syndrome." Cochrane Database Syst Rev 3: CD008419.

Quotation for this page:

Alexander Pope's line in An Essay on Man ( 1733 ): 'Hope springs eternal in the human breast'.