Vertigo-unsolved Mystery (Meniere’s Disease) Care Redefined: Insights from a Tertiary Care Center

BACKGROUND: Meniere's disease remains a poorly understood inner ear disorder since its first description by Prosper Meniere in the early 1800s. Characterized by episodic vertigo, fluctuating hearing loss, and tinnitus, it continues to challenge clinicians due to its unpredictable course and variable treatment response. Lifestyle modification alone often fails to adequately control vertigo episodes. AIM AND OBJECTIVES: To assess the effectiveness of oral pharmacotherapy in controlling vertigo and stabilizing hearing in patients with Meniere's disease, and to develop a practical, non-invasive treatment protocol suitable for routine clinical use. MATERIALS AND METHODS: Patients diagnosed with Meniere's disease as per 1995 AAO-HNS criteria were managed with standard lifestyle advice followed by oral pharmacotherapy, including an antihistaminic agent (betahistine) and a combination of diuretics (furosemide and spironolactone). Treatment response was evaluated based on vertigo control, reduction in episode frequency, and stabilization of audiometric thresholds. Surgical options were considered only for patients with persistent, disabling vertigo despite maximal medical therapy. RESULTS: Lifestyle measures alone did not provide adequate vertigo control. In contrast, combined oral pharmacotherapy resulted in marked improvement, with significant reduction in vertigo frequency and satisfactory stabilization of hearing levels. Only a small proportion of patients required evaluation for surgical intervention. CONCLUSION: A regimen combining betahistine with diuretics offers a reliable, non-invasive, and effective approach to managing Meniere's disease. This protocol provides substantial vertigo control and hearing stabilization, and may be adopted as a first-line strategy before considering surgical options.