Key messages
Due to a lack of robust evidence, it is not clear whether any lifestyle or dietary changes used to treat Ménière's disease work to improve people's symptoms, despite their routine use in clinical practice. We also do not know if there are any risks associated with these interventions.
Larger, well-conducted studies are needed in order to identify whether any lifestyle or dietary changes may be effective, and assess whether they have any harmful effects.
Further work also needs to be done to find out how best to measure the symptoms of people with Ménière's disease, in order to assess whether treatments are beneficial or not. This should include the development of a 'core outcome set' - a list of things that should be measured in all studies on Ménière's disease.
What is Ménière's disease?
Ménière's disease is a condition that affects the inner ear. It causes repeated attacks of dizziness or vertigo (a spinning sensation), together with hearing problems, tinnitus (ringing, humming or buzzing noises in the ears) and a feeling of fullness or pressure in the ear. It usually affects adults, and starts in middle age.
How is Ménière's disease treated?
Oral medications (tablets) are often used as the first treatment for Ménière's disease. Other treatment options are also available (for example, injections into the ear or surgery). People with Ménière's disease are often advised to modify their diet, for example by reducing their intake of salt or caffeine, as these are thought to worsen the symptoms of the disease.
What did we want to find out?
We wanted to find out:
- whether there was evidence that any lifestyle or dietary modifications work at reducing the symptoms of Ménière's disease;
- whether the treatments might cause any harm.
What did we do?
We searched for studies that compared different types of lifestyle or dietary modifications to either no modifications or sham (placebo) treatment.
What did we find?
We found two studies, which included a total of 274 people. One lasted for three months and the other lasted for two years. They assessed different types of lifestyle and dietary changes.
One study looked at the use of 'specially processed cereals'. These are cereals that stimulate the body to produce antisecretory factor - a protein that acts to reduce fluid production and decrease inflammation. Vertigo was not specifically assessed in this study, so we do not know if the cereals made any difference to this symptom. The study authors did not report whether there were any harms associated with the cereals.
One study looked at whether sleeping in a darkened room or drinking plenty of water affected the symptoms of Ménière's disease. It was unclear whether these changes made a difference to vertigo symptoms, and the study did not report on potential harms of these interventions.
What are the limitations of the evidence?
We have very little confidence in the evidence because the studies conducted were small and had problems in their conduct, which means that the results may be unreliable. We found very little information on how the symptoms of Ménière's disease were affected by the different changes, and no information on potential harms. We also did not find any studies that considered other, more commonly used dietary changes - such as reducing the intake of salt or caffeine. Large, well-conducted studies are needed to try and work out whether different lifestyle and dietary modifications are effective.
How up-to-date is this evidence?
This evidence is up-to-date to September 2022.
The evidence for lifestyle or dietary interventions for Ménière's disease is very uncertain. We did not identify any placebo-controlled RCTs for interventions that are frequently recommended for those with Ménière's disease, such as salt restriction or caffeine restriction. We identified only two RCTs that compared a lifestyle or dietary intervention to placebo or no treatment, and the evidence that is currently available from these studies is of low or very low certainty. This means that we have very low confidence that the effects reported are accurate estimates of the true effect of these interventions. Consensus on the appropriate outcomes to measure in studies of Ménière's disease is needed (i.e. a core outcome set) in order to guide future studies in this area and enable meta-analyses of the results. This must include appropriate consideration of the potential harms of treatment, as well as the benefits.
Ménière's disease is a condition that causes recurrent episodes of vertigo, associated with hearing loss and tinnitus. Lifestyle or dietary modifications (including reducing the amount of salt or caffeine in the diet) are sometimes suggested to be of benefit for this condition. The underlying cause of Ménière's disease is unknown, as is the way in which these interventions may work. The efficacy of these different interventions at preventing vertigo attacks, and their associated symptoms, is currently unclear.
To evaluate the benefits and harms of lifestyle and dietary interventions versus placebo or no treatment in people with Ménière's disease.
The Cochrane ENT Information Specialist searched the Cochrane ENT Register; Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE; Ovid Embase; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 14 September 2022.
We included randomised controlled trials (RCTs) and quasi-RCTs in adults with Ménière's disease comparing any lifestyle or dietary intervention with either placebo or no treatment. We excluded studies with follow-up of less than three months, or with a cross-over design (unless data from the first phase of the study could be identified).
We used standard Cochrane methods. Our primary outcomes were: 1) improvement in vertigo (assessed as a dichotomous outcome - improved or not improved), 2) change in vertigo (assessed as a continuous outcome, with a score on a numerical scale) and 3) serious adverse events. Our secondary outcomes were: 4) disease-specific health-related quality of life, 5) change in hearing, 6) change in tinnitus and 7) other adverse effects. We considered outcomes reported at three time points: 3 to < 6 months, 6 to ≤ 12 months and > 12 months. We used GRADE to assess the certainty of evidence for each outcome.
We included two RCTs, one related to diet, and the other related to fluid intake and sleep. In a Swedish study, 51 participants were randomised to receive 'specially processed cereals' or standard cereals. The specially processed cereals are thought to stimulate the production of anti-secretory factor - a protein that reduces inflammation and fluid secretion. Participants received the cereals for three months. The only outcome reported by this study was disease-specific health-related quality of life.
The second study was conducted in Japan. The participants (223) were randomised to receive abundant water intake (35 mL/kg/day), or to sleep in darkness (in an unlit room for six to seven hours per night), or to receive no intervention. The duration of follow-up was two years. The outcomes assessed were 'improvement in vertigo' and hearing.
As these studies considered different interventions we were unable to carry out any meta-analysis, and for almost all outcomes the certainty of the evidence was very low. We are unable to draw meaningful conclusions from the numerical results.