Meniere's disease

An idiopathic inner ear disorder with a triad: recurrent rotational vertigo (20 minutes to 12 hours), fluctuating sensorineural hearing loss, and tinnitus. AAO-HNS 2020 and EAONO/JOS 2015 base therapy on salt and caffeine restriction, thiazide diuretics, and betahistine (EMA-approved outside the US; off-label in the US). With conservative failure: intratympanic glucocorticoid or gentamicin injections; labyrinthectomy as a last resort.

ICD-10 H81.01 drug

Also known as: Endolymphatic hydrops, Idiopathic endolymphatic hydrops

Drugs used for this condition

CBetahistineFirst line · Histamine analogue, antivertigo agentFirst-line for Meniere's disease to reduce vertigo attack frequency per EAONO/JOS 2015 and AAO-HNS 2020. Standard dose 16 mg three times daily or 24 mg twice daily for 6–12 months. Evidence is conflicting: BEMED 2016 (221 patients) showed no benefit over placebo at 48 mg or 144 mg/day over 9 months. EMA retained registration on historical data; FDA has not approved it in the US.

How to read tiers A–F

Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.

AStrong evidence – first or second line in international guidelines
BRecommended in selected cases
CStudy data contradict each other
DBenefit not proven, no documented harm
FDocumented harm, or risk without benefit