Meniere’s Disease Treatment in Singapore

Classic Meniere’s disease may present with the complete triad of symptoms: episodic vertigo, fluctuating hearing loss, and tinnitus, accompanied by aural fullness. This form may follow a pattern of unpredictable attacks followed by symptom-free periods. Patients may experience cardinal symptoms during episodes, with hearing loss potentially affecting low frequencies before possibly progressing to other frequencies over time.

*Individual symptoms and progression may vary.*

This variant may primarily affect hearing without significant vertigo episodes. Patients might experience fluctuating hearing loss and tinnitus, but minimal or no balance disturbances. The hearing loss pattern may be similar to classic Meniere’s, potentially starting with low-frequency sounds. This form could progress to include vertigo symptoms over time, possibly developing into classic Meniere’s disease in some cases.

*Individual progression and outcomes may vary.*

Vestibular Meniere’s may present predominantly with vertigo episodes whilst hearing remains relatively preserved. Patients might experience recurring vertigo attacks with minimal hearing loss or tinnitus. This variant can be challenging to diagnose as the absence of hearing symptoms may delay recognition of the underlying condition. Some patients with this form may later develop hearing-related symptoms.

*Individual symptom patterns and progression may vary.*

• Rotational vertigo lasting 20 minutes to 24 hours
• Nausea and vomiting accompanying vertigo
• Fluctuating hearing loss, particularly for low frequencies
• Tinnitus (ringing, buzzing, or roaring sounds)
• Aural fullness or pressure sensation
• Imbalance and difficulty walking
• Sweating and rapid eye movements (nystagmus)
• Anxiety during attacks

• Mild hearing loss
• Low-level tinnitus
• Occasional balance uncertainty
• Fatigue from previous episodes
• Anxiety about future attacks
• Mild aural fullness

• Hearing loss developing over the years
• Chronic imbalance issues
• Drop attacks (sudden falls without warning)
• Bilateral ear involvement
• Tinnitus is becoming more noticeable
• Cognitive fatigue from chronic symptoms

Symptoms typically begin with aural fullness hours or days before a vertigo attack. The unpredictable nature of episodes can cause anxiety, with patients often modifying their lifestyles to avoid potential triggers.

Dietary adjustments form the foundation of Meniere’s disease management. Salt restriction may help reduce inner ear fluid accumulation. Consistent meal timing and adequate hydration can help maintain stable fluid balance. Caffeine and alcohol limitation may reduce symptom triggers. Stress management through meditation, yoga, or counselling can address this potential trigger factor. Regular sleep schedules and avoiding sudden head movements may help minimise episode frequency.

Betahistine may improve inner ear blood flow and reduce fluid pressure, taken regularly for prevention rather than acute treatment. Diuretics may reduce overall body fluid levels, potentially decreasing inner ear fluid accumulation. Anti-vertigo medications, including meclizine or dimenhydrinate, can provide symptom relief during acute episodes. Corticosteroids may be prescribed during episodes to reduce inner ear inflammation. Anti-nausea medications can help manage associated symptoms during attacks.

Steroid injections directly into the middle ear can provide targeted anti-inflammatory effects with minimal systemic side effects. This treatment involves inserting medication through the eardrum under local anaesthesia during an office procedure. Gentamicin injections may selectively affect vestibular cells while preserving hearing, potentially reducing vertigo episodes. Treatment frequency varies from single injections to series over several weeks, depending on response.

The Meniett device delivers low-pressure pulses to the inner ear through a ventilation tube. Patients use this portable device at home three times daily for five minutes per session. Treatment aims to improve inner ear fluid drainage and may reduce episode frequency. Effectiveness varies among patients.

Specialised physical therapy can help compensate for inner ear damage and improve balance function. Exercises include gaze stabilisation, balance training, and habituation movements. Regular therapy sessions combined with home exercises may optimise outcomes. This approach may particularly benefit patients between episodes or those with chronic imbalance.

Endolymphatic sac decompression may reduce inner ear fluid pressure while preserving hearing and balance function. This procedure involves removing bone around the endolymphatic sac to improve drainage. Vestibular nerve section may eliminate vertigo while preserving hearing, but requires craniotomy. Labyrinthectomy completely removes inner ear balance function, reserved for patients with non-functional hearing. Surgical options are considered when medical management fails after adequate trial periods.