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Systematic Review
A Systematic Review of Diuretics in the
Medical Management of Me´nie` re’s Disease
Otolaryngology–
Head and Neck Surgery
2016, Vol. 154(5) 824–834
American Academy of
Otolaryngology—Head and Neck
Surgery Foundation 2016
Reprints and permission:
DOI: 10.1177/0194599816630733
Matthew G. Crowson, MD1 , Aniruddha Patki, MD1 , and
Debara L. Tucci, MD, MS, MBA1
Sponsorships or competing interests that may be relevant to content are dis-
closed at the end of this article.
Abstract
Objective. (1) Review evidence for the use of oral diuretic
medications in the management of Me´nie`re’s disease. (2)
Analyze therapy-related hearing and vertigo outcomes.
Data Sources. Literature was obtained through directed
searches of MEDLINE, EMBASE, Web of Science, EBSCO
Host, Cochrane Reviews, and linked citations through semi-
nal papers. We searched independent electronic databases
for articles that reported the use of diuretics in patients
with Me´nie`re’s disease.
Review Methods. All articles of level 4 evidence or higher, per
the Oxford Centre for Evidence-Based Medicine, were included
with no limit for number of patients, duration of therapy, or
follow-up period. Two independent investigators reviewed the
articles for inclusion eligibility. Outcomes were tabulated, includ-
ing subjective or quantitative measures of hearing, tinnitus, ver-
tigo episode frequency, and medication adverse effects.
Results. Nineteen articles were included from 1962 to 2012
from 11 countries. Twelve retrospective case series, 4 rando-
mized controlled trials, 2 case-control trials, and 1 prospective
case series were identified. Six studies investigated isosorbide; 5,
hydrochlorothiazide; 2, acetazolamide; 2, chlorthalidone; and 1
each of betahistine, hydrochlorothiazide, chlorthalidone, acetazo-
lamide, hydrochlorothiazide-triamterene, and nimodipine. Eight
(42.1%) studies reported hearing outcomes improvement.
Fifteen (79.0%) studies reported vertigo outcomes improve-
ment. Ten (52.6%) studies reported no side effects, and 4 stud-
ies (21.1%) reported abdominal discomfort. No significant
morbidity or mortality was reported in any study.
Conclusion. Multiple low evidence–level studies report that
oral diuretic therapy may be beneficial in the medical man-
agement of Me´nie`re’s disease. Improvement in vertigo epi-
sode frequency was consistently reported, with less
convincing evidence for improvement in hearing outcomes.
Keywords
Me´nie`re’s disease, diuretics, conservative therapy, medical
management
Received September 22, 2015; revised January 7, 2016; accepted
January 14, 2016.
M e´nie`re’s disease (MD) or syndrome is a relatively
common condition of the inner ear that may
affect up to 190 per 100,000 people in the United
States.1 Prevailing theories on its pathogenesis point to
endolymphatic hydrops as one derangement responsible for
producing dysfunction within the cochlea and peripheral
vestibular apparatus. While the exact pathophysiology
remains unknown, it is held by many that hydrops of the
endolymph within the labyrinth is contributory.2 It is
believed that during an acute attack, pressure within the
scala media increases to a critical point where either a
‘‘stretch’’ or rupture of Reissner’s membrane ensues.3,4 This
event results in admixture of endolymph and perilymph
leading to disruption of the ionic gradient, ultimately pro-
ducing the classic symptoms of fluctuating hearing loss, tin-
nitus, and aural fullness.
As firm evidence of a unifying pathogenic mechanism is
lacking, MD has proven difficult to successfully manage.
Options for therapy range from low-salt diet restriction and
diuretics to benzodiazepine and steroid regimens for acute
attacks. Invasive surgical procedures are considered in
refractory cases. Despite the widespread use of diuretics for
this condition, limited evidence for its efficacy has been
demonstrated in published literature. An excellent systema-
tic review of the effect of diuretic treatment in MD patients
was published in 2006 and subsequently updated in 2010.5
The authors found that there were no trials of high enough
quality to meet the standards for their systematic review.
Clinical recommendations and guidelines are best sup-
ported by data and evidence generated through high-quality
1Division of Head and Neck Surgery and Communication Sciences,
Department of Surgery, Duke University Medical Center, Durham, North
Carolina, USA
This article was presented at the 2015 AAO-HNSF Annual Meeting & OTO
EXPO; September 27-30, 2015; Dallas, Texas.
Corresponding Author:
Matthew G. Crowson, MD, Duke University Medical Center, Division of
Head and Neck Surgery and Communication Sciences, 2301 Erwin Road,
Durham, NC 27710, USA.
Email:
Reprinted by permission of Otolaryngol Head Neck Surg. 2016; 154(5);824-834.
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