Therapeutic strategies in the treatment of Menière's disease: the Italian experience

Eur Arch Otorhinolaryngol. 2019 Jul;276(7):1943-1950. doi: 10.1007/s00405-019-05423-7. Epub 2019 Apr 11.


Purpose: Ménière's disease (MD) is an inner ear disorder of unknown etiology, whose pathological substrate is the endolymphatic hydrops. Different treatments have been proposed; however, evidence of their effectiveness is lacking. The aim of this study was to evaluate by a questionnaire which medical and surgical treatments are used in Italy for the treatment of MD and to compare them with those proposed in other countries.

Methods: An electronic questionnaire of 40 questions was formulated and sent to Italian otolaryngologist (ENT) divided into two groups: Group 1 ("generalists" 60.8%) and Group 2 ("neurotologist- NO" 39.2%).

Results: One hundred and twenty five ENT replied. Treatment of the acute phase, apart from symptomatics, was based on diuretics that are prescribed by 83.5% of respondents, steroids, prescribed by 66.7%, and vasodilators, prescribed by 22%. In the intercritical phase, 87.2% of respondents recommended low-salt diet, 78.4% of respondents prescribed betahistine, and 52.8% diuretics. Statistical analysis did not show correlation neither with the declared specialization nor with the number of patients treated. In case of failure of medical treatment, IT gentamicin was suggested by 48.8% of the respondents and IT steroids by 40.8%. Statistical analysis showed that generalists prefer IT steroids and NO IT gentamicin (p 0.019). In case of failure of both medical treatment and IT treatment, vestibular neurectomy was indicated by 58.4% of the respondents, 6.4% indicated endolymphatic sac surgery, and 2.4% surgical labyrinthectomy.

Conclusion: In Italy, the treatment of MD stand on a gradual approach that starts from the dietary-behavioral changes and a pharmacological therapy based on betahistine. In refractory cases, IT treatment initially with steroids and, therefore, with gentamicin allows the control in vertigo in the majority of cases. In case of failure of IT treatment, VNS is the surgery of choice.

Keywords: Medical therapy; Menière; Questionnaire; Surgery.

MeSH terms

  • Betahistine / therapeutic use*
  • Cross-Cultural Comparison
  • Diet, Sodium-Restricted / methods*
  • Gentamicins / therapeutic use*
  • Glucocorticoids / therapeutic use*
  • Humans
  • Italy / epidemiology
  • Meniere Disease* / diet therapy
  • Meniere Disease* / drug therapy
  • Meniere Disease* / epidemiology
  • Meniere Disease* / surgery
  • Otolaryngology* / methods
  • Otolaryngology* / statistics & numerical data
  • Otologic Surgical Procedures / methods*
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Protein Synthesis Inhibitors / therapeutic use
  • Surveys and Questionnaires
  • Vasodilator Agents / therapeutic use


  • Gentamicins
  • Glucocorticoids
  • Protein Synthesis Inhibitors
  • Vasodilator Agents
  • Betahistine