Migraine, dyslipidemia, obesity, diabetes, sleep apnea, hypertension, and atherosclerosis are among the major factors that often require medical management. Screening for risk factors is performed at presentation. Control of risk factors for cerebrovascular ischemia is combined with treatment of pressure dysfunction in the hydropic ear. Evidence of efficacy is lacking for most interventions other than ablation.Īt our institution, Ménière’s disease is treated as a cerebrovascular disorder. Surgical procedures include intratympanic steroid perfusion, shunts, and ablative procedures when conservative treatments fail. Pharmacologic treatments include diuretics, migraine prophylactic medications, histamine analogs, and oral steroids. Present dietary methods of control include sodium restriction and migraine trigger elimination. Past treatments have focused on relieving elevated pressures in the hydropic ear and more recently on treatment of underlying migraine. The lack of a widely accepted mechanism of the disease has also delayed the development of rational treatments. Confusion in the nomenclature of Ménière’s disease and lack of a standard definition of the disorder until 1995 has hampered accurate assessment of treatment efficacy since the presently defined disorder was first described in 1938.
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