This handout is for ménière's disease (recurrent audiovestibular hydrops). Your care team identified this based on: recurrent spontaneous episodic vertigo, each spell lasting 20 min to 12 h, with nausea/imbalance, recovering between attacks — the defining ménière vertigo window (bárány/aao-hns criteria, lopez-escamez j vestib res 2015; aao-hns cpg basura 2020).
Other reasons your team may use this plan: fluctuating unilateral hearing loss + tinnitus + aural fullness (especially worse around vertigo spells) — the cochlear arm of the ménière tetrad (lopez-escamez 2015; basura ohns 2020); audiogram showing low-to-mid-frequency sensorineural hearing loss in one ear (documented before/during/after a vertigo episode) — the objective diagnostic anchor that defines definite md (lopez-escamez j vestib res 2015 — audiometric documentation required); established / recurrent ménière on a longitudinal problem list (≥2 prior definitive spells, on stepped therapy, or escalating frequency) — chronic stepped-care + bilaterality-surveillance entry (huppert acta otolaryngol 2010 — bilaterality rises with duration; aao-hns cpg 2020).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| prochlorperazine | 5-10 mg | PO/IM/buccal/IV | q6-8h PRN, short course | AAO-HNS CPG Basura 2020 — symptomatic acute-attack control; antiemetic/vestibular suppressant for the spell only. Counsel extrapyramidal/akathisia risk; avoid chronic dosing (impairs vestibular compensation; falls/EPS in elderly). |
| dimenhydrinate | 50 mg | PO/IM/IV | q4-6h PRN, short course | Short-term antiemetic/vestibular-suppressant bridge for the acute spell (AAO-HNS CPG 2020 symptomatic care); limit to the attack — chronic use delays compensation. |
| meclizine | 25 mg | PO | q6-8h PRN, short course | Vestibular suppressant for symptomatic acute-attack relief only; not disease-modifying — STOP once the spell resolves (AAO-HNS CPG 2020). |
| ondansetron | 4-8 mg | PO/ODT/IV | q8h PRN, short course | Antiemetic for intractable vomiting where antidopaminergics are contraindicated (Parkinsonism/EPS risk); monitor QT; symptomatic only. |
| diazepam | 2-5 mg | PO/IV | single / very short course only | A single low dose for extreme refractory attack distress only; benzodiazepines markedly impair vestibular compensation and increase falls (esp. elderly) — explicitly avoid ongoing/maintenance use (AAO-HNS CPG 2020). |
Plan: Ménière's disease — acute-attack symptomatic relief + stepped maintenance ladder (medical → intratympanic → surgical)
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
CHRONIC longitudinal arc (the core differentiator): structured neurotology + audiology follow-up with the stepped ladder revisited at each interval; vestibular rehabilitation for residual imbalance; hearing rehabilitation (hearing aid; cochlear implant if profound and the contralateral ear is also affected); psychological support (MD has high anxiety/depression burden); DRIVING and OCCUPATIONAL safety counselling (unpredictable vertigo / Tumarkin — fitness-to-drive reporting per jurisdiction); bilaterality surveillance and hearing-preservation planning; route elderly recurrent drop-attack patients to geriatrics.falls.core.v1 for the multifactorial falls programme.
Guideline: AAO-HNS Clinical Practice Guideline: Ménière's Disease — Basura et al, Otolaryngol Head Neck Surg 2020 (PMID 32267799; Executive Summary PMID 32267820) + Bárány Society Ménière diagnostic criteria — Lopez-Escamez et al, J Vestib Res 2015 (PMID 25882471) + BEMED betahistine RCT (Adrion/Strupp, BMJ 2016, PMID 26797774) + intratympanic methylprednisolone vs gentamicin (Patel et al, Lancet 2016, PMID 27865535) + Cochrane 2023 (Webster et al — IT gentamicin PMID 36847592, IT corticosteroids PMID 36847608, systemic pharmacology incl. betahistine/diuretics PMID 36827524) + vestibular neurotomy for disabling MD/Tumarkin (Véleine et al, J Neurosurg 2022, PMID 34996039) + natural history (Huppert/Strupp/Brandt, Acta Otolaryngol 2010, PMID 20001444). Reconciled 2026-05-17 — PubMed-verified; the 2020 AAO-HNS CPG + 2015 Bárány criteria are the current operational standard, no superseding guideline 2021-2026.