Medical treatment of fluctuant hearing loss in Meniere's disease.

Fluctuations in hearing are thought to reflect varying degrees of endolymphatic hydrops. Spontaneous fluctuations are often reported by patients with idiopathic Meniere's disease and have been verified by audiometry in more than 50% of cases. The hearing loss occurs mainly during the first 5 to 10 years of the disease. It is therefore important to commence therapy, regardless of type, at an early stage. The varying course of the disease makes it difficult to assess the effect of medical treatment. Widely accepted recommendations include special diet, salt restriction, diuretics, corticosteroids, and vasodilators. Among diuretics, benzthiazides, potassium-sparing types, and furosemide have been considered beneficial. Transient improvement in hearing can be achieved by osmotic expanders such as glycerol, urea, mannitol, and isosorbide. Glycerol and urea have been widely used as test substances for confirmation of suspected endolymphatic hydrops. Urea and isosorbide, both of which can be taken orally, have also been used for medication.