Meniere and vertigo

  • Meniere disease: triad of episodic vertigo, tinnitus, hearing loss
  • Meniere syndrome: above from other inner ear disorders

Treatment

  • Avoid high salt, caffeine, alcohol, nicotine, stress MSG
  • Vestibular rehabilitation
  • Vasodilator: Betahistine 8-16 mg tid, available only as compounded preparation in US
  • Diuretic: hctz 25 mg/Triamterene 37.5 mg = Dyazide
  • As needed
    • vestibular suppressant:
      • meclizine 25-50 mg q6 prn
      • Alprazolam 0.5 mg q6 as needed
      • Lorazepam 1-2 mg q8 prn
    • antiemetics:
      • Ondansetron (Zofran) 4 mg q8 as needed
      • Metoclopramide (Reglan) 5-10 mg q 6 as needed
Different types of vertigo

Reference