Diuretic and diet effect on menière's disease evaluated by the 1985 committee on hearing and equilibrium guidelines

Abstract

Fifty-four patients, diagnosed with Menière's disease and treated with diuretics and a low-salt diet, were evaluated retrospectively with the 1985 AAO/HNS Committee on Hearing and Equilibrium (CHE) guidelines for vertigo and hearing changes. The patient data base was also evaluated with other methods that helped determine the effectiveness of the 1985 AAO/HNS CHE guidelines. After 24 months of therapy, vertigo control was complete or substantial in 79% of the patients, limited or insignificant in 19%, and worse in 2% as evaluated by the CHE 1985 guidelines. Hearing improved in 35% of the patients, was unchanged in 29%, was worse in 22%, and could not be classified by CHE guidelines in 14%. Hearing was also evaluated by comparison of individual thresholds before medical therapy, and at 22 and 74 months after the start of medical therapy. We found a stabilization of low- and mid-threshold frequencies, with an average rate of hearing loss approximating 0 dB/yr with 74 months of followup. The results of this preliminary study suggest that diuretics and a low-salt diet may decrease the natural progression of sensorineural hearing loss in patients with Menière's disease. Compared with other methods of data analysis, the 1985 CHE guidelines lacked sensitivity to evaluate the hearing changes observed.

Changes in the Three-Dimensional Angular Vestibulo-Ocular Reflex following Intratympanic Gentamicin for Ménière's Disease

“…Our previous experience with this protocol has shown that fewer than 5% of patients experience hearing loss as a consequence of the gentamicin treatment (Minor 1999). Long-term changes (>6 months) in hearing after intratympanic gentamicin have not differed from the natural history of hearing loss in patients with Me Ânie Áre's disease who have not received intratympanic gentamicin (Santos et al 1993). …”

Chiropractic management of a 40-year-old female patient with Ménière disease

“…A low-salt diet (ie, less than 1 to 2 g of salt per day) and diuretics (ie, most commonly the combination of hydrochlorothiazide and triamterene) are commonly prescribed. 19,20 However, in a recent Cochrane review, 11 the authors concluded that "there is no good evidence for or against the use of diuretics in [MD] or syndrome" and recommended further research. For patients who do not respond to diet and diuretic treatment, oral steroid or intratympanic steroid injection can be attempted.…”

Vestibular vertigo treatment in a polymorbid patient

“…Огра-ничение количества соли до 2-3 г в сутки обычно рекомен-дуется в рамках начальной терапии [17], хотя данных, под-тверждающих эффективность такой диеты, нет [18]. Ежедневное потребление соли должно быть равномерно распределено между приемами пищи.…”

“…В двойном слепом плацебоконтролируемом исследовании показано, что диуретики и бетагистина ди-гидрохлорид -единственные препараты с доказанной эф-фективностью для уменьшения частоты приступов голово-кружения [19]. В настоящий момент нет данных рандоми-зированных или проспективных исследований, посвящен-ных эффективности оральных глюкокортикоидов (ГК) у па-циентов с болезнью Меньера, однако многие авторы реко-мендуют системную терапию ГК, исходя из возможной им-мунологической этиологии развития гидропса [18].…”