Optimal management of Ménière’s disease

Figures & data

Table 1 Cerebrovascular risk factor screening in Ménière’s patients

Risk factor by history	Serum testing	Other tests
Migraine		Magnetic resonance imaging
Dyslipidemia	Lipoproteins
	Triglycerides
	Total cholesterol
Obesity	Lipoproteins
	Triglycerides
	Total cholesterol
Hypertension	Electrolytes, BUN, creatinine
Smoking	Lipoproteins
	Triglycerides
	Total cholesterol
Diabetes	Fasting glucose
	Hemoglobin A1C
	Lipoproteins
	Triglycerides
	Total cholesterol
Sleep apnea	C-reactive protein	Polysomnography
	Fasting glucose
	Lipoproteins
	Triglycerides
	Total cholesterol
Myocardial infarction, stroke	C-reactive protein	Magnetic resonance imaging
Transient ischemic attacks	Lipoproteins	Electrocardiography
Known atherosclerotic disease	Triglycerides
	Total cholesterol
Autoimmune disease	ESR
	C-reactive protein
Coagulopathies	CBC, PT, APTT
	Lupus anticoagulants
	(selected patients)

Abbreviations: BUN, blood urea nitrogen; ESR, erythrocyte sedimentation rate; CBC, complete blood count; PT, prothrombin time; APTT, partial thromboplastin time.

Table 2 Treatment matrix for vascular risk factors

Risk factor	Medication	Other treatments
Migraine	Tricyclics	Migraine trigger elimination
	Calcium channel blockers	Magnesium supplements
	Carbonic anhydrase inhibitors	Refer treatment failures to neurology
	Topiramate
	Acetazolamide
Dyslipidemia	Statins	Nutritional counseling
	Low-dose aspirin
	Diuretic
Obesity	Low-dose aspirin	Nutritional counseling
Hypertension	Low-dose aspirin antihypertensives	Coordinate management with internist
	Diuretics
	Beta blockers
	Calcium channel blockers
Smoking	Low-dose aspirin	Smoking cessation program
	Diuretic
	Statins
Diabetes	Low-dose aspirin	Referral to endocrinology
	Diuretic
	Statins
Sleep apnea	Low-dose aspirin	CPAP or surgical treatments
	Diuretic
Myocardial infarction, stroke	Low-dose aspirin	Coordinate management with internist
Transient ischemic attacks	Diuretic
Known atherosclerotic disease	Statins
Autoimmune disease	Transtympanic or oral steroids	Referral to rheumatology
	Diuretic
Coagulopathies	Low-dose aspirin	Referral to hematology
	Diuretic

Abbreviation: CPAP, continuous positive airway pressure.