Ménière's disease. A practical approach to management.

The management of Ménière's disease continues to provide a formidable clinical challenge, mainly because its precise aetiology is unknown. The unpredictable natural history of the condition has consistently bedevilled attempts to evaluate therapeutic efficacy, and there have been no entirely satisfactory prospective controlled clinical trials of any specific medical or surgical treatment. Although no form of medication has been convincingly shown to influence the long term course of the disease, many drugs may be useful in the control of vertigo. In recent years conservation of hearing has assumed equal importance to the control of vertigo as the therapeutic goal. Indications for conservative endolymphatic sac surgery, which appears to offer the best prospect of preventing the progressive deafness which invariably accompanies the established condition, are discussed. The necessity for a flexible therapeutic approach to the management of Ménière's disease is underlined.