How to Manage Ménière's Disease

What is Ménière's disease?

Ménière’s disease is an inner ear condition that causes attacks of vertigo (spinning) lasting 20 minutes to 12 hours, along with hearing loss, ringing (tinnitus) and a full feeling in the affected ear. It is linked to too much fluid pressure in the inner ear, and it usually affects one ear. Our article What Is Ménière’s Disease? covers the symptoms and how it is diagnosed.

What should I do during an attack?

• Sit or lie down right away, somewhere you cannot fall. Lying flat and still usually helps most.
• Keep your eyes on one fixed point, and keep your head still.
• Take your attack medicine if we prescribed one for vertigo or nausea. These medicines are for attacks only: taking them every day can slow your brain’s ability to adjust.
• Keep a bowl or bag nearby in case of vomiting, and sip fluids once the nausea settles.
• Rest. Many people fall asleep and feel better when they wake up. You may feel tired or unsteady for a while afterward.

How can I have fewer attacks?

• Sodium: aim for 1,500 to 2,000 mg a day. One teaspoon of salt has about 2,300 mg, so this means about 500 to 650 mg at each meal, spread evenly through the day instead of one salty meal. On a Nutrition Facts label, 5% Daily Value or less per serving is low in sodium and 20% or more is high. Processed foods, canned soups, deli meats, bread, sauces, restaurant meals and snacks hold most of the sodium in a typical diet, more than the salt shaker does.
• Water: drink steadily through the day. In one study, people who drank about 35 mL of water per kilogram of body weight a day had fewer attacks. That is about 10 cups (2.5 liters) a day for a 160-pound person. If you have heart failure or kidney disease, or have been told to limit fluids, ask us first.
• Caffeine: try a month without it. Research has not found a safe amount for Ménière’s or proven that caffeine causes attacks. Cut down over 1 to 2 weeks to avoid withdrawal headaches, then use your diary to see whether your attacks change. If they do not, up to 1 cup of coffee a day (about 100 mg of caffeine) is a reasonable limit. Tea, cola, energy drinks and chocolate count too.
• Alcohol: no more than 1 drink a day, and less if your diary shows attacks after drinking. One drink is a 12-ounce beer, a 5-ounce glass of wine or 1.5 ounces of liquor.
• Do not smoke or vape.
• Sleep at least 7 hours a night, in a dark room, going to bed and getting up at about the same times every day.
• Manage stress, which can bring on attacks in some people. Regular exercise, relaxation practice and enough sleep all help.
• Stay active: about 30 minutes of moderate activity, such as brisk walking, on most days, without pushing to exhaustion.
• Take any daily medicine as prescribed, such as a water pill (diuretic). Do not stop it on your own.

The research on these diet and habit changes is limited, and they do not help everyone, but they are low risk and worth trying for at least 2 to 3 months while you keep your diary. Daily medicines such as a water pill also help some people, though the research on them is limited too. Another daily medicine, betahistine, is widely used in other countries. It is not FDA-approved in the United States, but we sometimes prescribe it through a compounding pharmacy. Ask us whether it is right for you.

Many people with Ménière’s disease also have migraine, and treating the migraine can mean fewer dizzy spells. Ask us whether migraine could be part of your symptoms, and see our migraine guide.

Should I keep a diary?

Yes. Write down the date and length of each attack, how severe it was, what your hearing and ear felt like, and anything that might have set it off, such as a salty meal, poor sleep or stress. Bring it to your visits: it shows us how well treatment is working and helps you spot your own triggers.

What if attacks keep coming?

If habits and daily medicine are not enough, there are other options. We will talk through which fits you best, based on how often your attacks come and how your hearing is doing.

• Steroid injections through the eardrum, done in the office. They rarely affect hearing, so they are usually tried first while your hearing in that ear is still useful. See ear steroid injections.
• Gentamicin injections through the eardrum, which control vertigo in most people but are more likely to reduce hearing in that ear.
• Balance therapy (vestibular rehabilitation) with a physical therapist, for unsteadiness between attacks, and to help your balance recover after gentamicin or surgery. It does not stop the attacks themselves.
• Hearing aids if hearing loss becomes lasting.
• Surgery, for the few people whose vertigo stays disabling despite other treatment.

When should I call?