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Meniere's Disease treatments that may be placebos
Timothy C. Hain, MD 
Page last modified:
January 9, 2008
It is best to be skeptical about new treatments for Meniere's. Because the 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).
There is very little evidence that any currently available treatment, whether it be medical or surgical, changes hearing.
There is 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.
A full discussion is under the link. We recommend a try of betahistine because the cost/benefit ratio is reasonable.
This is a homeopathic remedy, and therefore 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.
The endolymphatic shunt is used by some doctors 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.
Shunts are often recommended by otologic surgeons (Kim et al, 2005). Unfortunately, while the shunt would seem to be a logical thing to do, in most studies, the shunt procedure does not appear to be better than doing nothing (e.g. Silverstein and Rosenberg, 1992), or doing a sham (placebo) surgery (Bretlau et al, 1981; Thomsen et al, 1981, see references below). This lack of effect may be because the shunt can easily get plugged up, or because what it is treating (hydrops) is a symptom itself rather than a cause of symptoms. We favor the first explanation.
We do not presently recommend this procedure for our 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). A recent trend is to make an attempt to damage the sac, in addition to improving its drainage. As the sac is the immune organ of the ear, this idea makes sense if one is attempting to immunosuppress the ear. More about shunt surgery can be found here.
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.
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| Intratympanic injection of medication. |
We have recently moved this discussion into the main Menieres page, as it seems now to be a "emergent" treatment rather than a 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. Rask-Andersen et al. (Otol HNS 2005, 133, 441-443). These authors 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.
Price et al (Arch Otol HNS 120:209-11, 1994) reported a case where Lupron alleviated the symptoms of Menieres. 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.
This device, which is sold in the US by Medtronics, incorporates a ventilation tube and pulsed pressure to the middle ear using a device that appears rather similar to an aquarium pump. It costs $3500. It is reported to reduce attacks by roughly a factor of two. We have not observed this effect in patients that we have followed.
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".
Surgery is required to use this device, and the device itself is expensive (about $3500). According to the manufacturors web site (see link), less than 100 patients have been used in studies which suggest its effectiveness. A recent 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 autoimmune based theories of the etiology of Menieres.
Fortunately, one can get a refund of the $3500 price of the Meniett device itself if it is ineffective (at 6 weeks). At this writing (mid 2006), we advise considerable caution. It might be considered just prior to going on to a destructive treatment. 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.
(Gabapentin). Comment: This new drug which is indicated for treatment of seizures 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.
Recently 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.
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 Menieres. 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 Menieres. However, nearly everyone agrees that treatment does influence dizziness.
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 below). Eustachian tube malfunction does not appear to generally modulate Meniere's disease (Maier et al, 1997).
A homeopathic medication. A variant of cocculus, almost certainly a placebo. A recent study suggested that Vertigo-Heel was equally effective to betahistine (Serc) (Klein, 1998). This doesn't say much for Serc.
This element has also been suggested as being helpful for vertigo. There are -0- references on this in Pubmed. Most feel that Zinc is a placebo when used to treat Meniere's disease.
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