Condition

Meniere's Disease

Inner ear disorder causing vertigo and hearing loss

17M
People Affected
4
Active Trials
340K
New Cases/Year
100
Deaths/Year

Treatment Rankings

Ranked by evidence volume first. Medicine has spent centuries ranking things by vibes. This is an improvement.

1
Intratympanic Gentamicin
83% Effectiveness• 85% Confidence• 55% Safety• 2 trials• 4.5K participants
HIGH EvidenceModerate ValueDose: 20-40 mg/mL, 0.3-0.5 mL per injection
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Comparative Safety Scale(Higher is safer)

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Meth💀
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55
DangerousModerateSafe

Time to Effect

Days to weeks

Duration

1-4 injections per series

Response Rate

88%

Remission Rate

70%

Number Needed to Treat (NNT)

3

Number Needed to Harm (NNH)

5

Common Side Effects:

Permanent hearing loss: 20%
Transient vertigo: 15%
Ear discomfort: 8%
Tinnitus: 7%

Annual Cost of Care

Drug Cost

$50

Monitoring

$600

Side Effects

$300

Total Annual

$2,500

Cost-Effectiveness

MODERATE

QALYs Gained

0.55

Cost per Remission

$3,571

Cost per Responder

$2,941

Treatment Outcomes
Primary Outcomes
Vertigo Attack FrequencyAverage 4.5 attacks/month
-85% (-3.8 attacks/month)
Dizziness Handicap Inventory (DHI) ScoreDHI score: 55/100 (severe handicap)
-60% (-33 points)
Aural Fullness Visual Analog Scale (VAS) ScoreVAS score: 7/10
-50% (-3.5 points)
Secondary Benefits
Tinnitus Handicap Inventory (THI) ScoreTHI score: 40/100 (moderate handicap)
-20% (-8 points)
Pure Tone Average (PTA) in Affected EarPTA: 45 dB HL
+5% (+2.25 dB HL)
Functional Level Scale (FLS) ScoreFLS score: 4 (moderate disability)
-40% (-1.6 points)
Common Side Effects
Permanent hearing loss
+20%
Transient vertigo
+15%
Ear discomfort
+8%

Clinical Trial Phases:

Phase 4
2
Intratympanic Dexamethasone
78% Effectiveness• 80% Confidence• 70% Safety• 8 trials• 3.5K participants
MODERATE EvidenceGood ValueDose: 10-24 mg/mL, 0.3-0.5 mL per injection
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Comparative Safety Scale(Higher is safer)

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Meth💀
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Chemo☢️
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70
DangerousModerateSafe

Time to Effect

Days to 2 weeks

Duration

As needed, usually 1-3 injections per flare-up or series

Response Rate

75%

Remission Rate

50%

Number Needed to Treat (NNT)

4

Common Side Effects:

Ear discomfort/pain: 15%
Transient vertigo: 7%
Ear infection: 3%
Tympanic membrane perforation: 1%

Annual Cost of Care

Drug Cost

$30

Monitoring

$450

Side Effects

$50

Total Annual

$2,000

Cost-Effectiveness

GOOD

QALYs Gained

0.45

Cost per Remission

$4,000

Cost per Responder

$2,667

Treatment Outcomes
Primary Outcomes
Vertigo Frequency10 attacks/month
-60% (-6 attacks/month)
Tinnitus SeverityTinnitus Handicap Inventory (THI) score: 50/100
-15% (-7.5 points)
Aural FullnessAural Fullness Visual Analog Scale (VAS): 7/10
-35% (-2.5 points)
Pure Tone Average (PTA) Hearing LossPTA (0.5, 1, 2, 3 kHz) in affected ear: 50 dB HL
-10% (-5 dB HL)
Secondary Benefits
Dizziness Handicap Inventory (DHI)DHI score: 60/100
-25% (-15 points)
Functional Impairment ScoreFunctional Impairment Score (0-10): 6/10
-30% (-1.8 points)
Speech Discrimination Score (SDS)SDS (affected ear): 70%
+5% (+3.5%)
Common Side Effects
Ear discomfort/pain
+15%
Transient vertigo
+7%
Ear infection
+3%

Clinical Trial Phases:

Phase 4
3
Endolymphatic Sac Decompression
75% Effectiveness• 75% Confidence• 60% Safety• 25 trials• 2K participants
MODERATE EvidenceModerate ValueDose: Single surgical procedure
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Comparative Safety Scale(Higher is safer)

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60
DangerousModerateSafe

Time to Effect

Weeks to months

Duration

Single surgery

Response Rate

75%

Remission Rate

60%

Common Side Effects:

Hearing loss: 7%
Tinnitus changes: 5%
CSF leak: 1%
Infection: 1%

Annual Cost of Care

Drug Cost

$0

Monitoring

$400

Side Effects

$100

Total Annual

$2,000

Cost-Effectiveness

MODERATE

QALYs Gained

0.65

Cost per Remission

$3,333

Cost per Responder

$2,667

Treatment Outcomes
Efficacy Outcomes
Overall Effectiveness
+75%
Response Rate
+75%
Remission Rate
+60%
Common Side Effects
Hearing loss
+7%
Tinnitus changes
+5%
CSF leak
+1%

Clinical Trial Phases:

Phase 4
4
Hydrochlorothiazide + Low Sodium Diet
68% Effectiveness• 75% Confidence• 68% Safety• 40 trials• 7.5K participants
MODERATE EvidenceExcellent ValueDose: HCTZ 12.5-25mg daily, low-sodium diet (<1500mg/day)
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Comparative Safety Scale(Higher is safer)

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Meth💀
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68
DangerousModerateSafe

Time to Effect

1-4 weeks

Duration

Lifetime

Response Rate

60%

Remission Rate

25%

Common Side Effects:

Dizziness: 8%
Fatigue: 7%
Hypokalemia: 12%
Increased urination: 25%

Annual Cost of Care

Drug Cost

$50

Monitoring

$450

Side Effects

$50

Total Annual

$500

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.2

Cost per Remission

$2,000

Cost per Responder

$833

Treatment Outcomes
Efficacy Outcomes
Overall Effectiveness
+68%
Response Rate
+60%
Remission Rate
+25%
Common Side Effects
Dizziness
+8%
Fatigue
+7%
Hypokalemia
+12%

Clinical Trial Phases:

Phase 4
5
Betahistine
65% Effectiveness• 65% Confidence• 78% Safety• 2 trials• 8K participants
MODERATE EvidenceExcellent ValueDose: 8-16mg three times daily (24-48mg/day)
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Comparative Safety Scale(Higher is safer)

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78
DangerousModerateSafe

Time to Effect

2 weeks to 3 months

Duration

Long-term

Response Rate

60%

Remission Rate

25%

Number Needed to Treat (NNT)

7

Common Side Effects:

Nausea: 8%
Headache: 5%
Indigestion: 4%

Annual Cost of Care

Drug Cost

$600

Monitoring

$400

Side Effects

$20

Total Annual

$900

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.25

ICER

$18,000/QALY

Cost per Remission

$3,600

Cost per Responder

$1,500

Treatment Outcomes
Primary Outcomes
Vertigo Attack Frequency6 attacks per month
-50% (-3 attacks per month)
Vertigo Attack Severity (VAS)Vertigo Severity Visual Analog Scale (0-10): 7/10
-40% (-2.8 points)
Tinnitus Handicap Inventory (THI) ScoreTinnitus Handicap Inventory (0-100): 55/100
-27% (-15 points)
Aural Fullness/Pressure (VAS)Aural Fullness Visual Analog Scale (0-10): 6/10
-33% (-2 points)
Secondary Benefits
Dizziness Handicap Inventory (DHI) ScoreDizziness Handicap Inventory (0-100): 65/100
-30% (-20 points)
Functional Level Scale (FLS)Functional Level Scale (1-10, 1=normal, 10=severe limitation): 5/10 (moderate limitation)
-40% (-2 points)
Overall Quality of Life (EQ-5D Utility Score)EQ-5D Utility Score (0-1, 1=perfect health): 0.68
+10% (+0.07 points)
Common Side Effects
Nausea
+8%
Headache
+5%
Indigestion
+4%

Clinical Trial Phases:

Phase 4
6
Vestibular Rehabilitation Therapy (VRT)
65% Effectiveness• 75% Confidence• 95% Safety• 1 trials• 6K participants
MODERATE EvidenceGood ValueDose: 30-60 min sessions, 1-3 times/week
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
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Exercise🏃
Water💧
95
DangerousModerateSafe

Time to Effect

4-12 weeks

Duration

6-12 weeks initial course, then home exercises

Response Rate

75%

Remission Rate

%

Common Side Effects:

Temporary increase in dizziness: 10%
Fatigue: 5%

Annual Cost of Care

Drug Cost

$0

Monitoring

$150

Side Effects

$0

Total Annual

$750

Cost-Effectiveness

GOOD

QALYs Gained

0.3

Cost per Responder

$1,000

Treatment Outcomes
Primary Outcomes
Dizziness Handicap Inventory (DHI) Score65/100 points (moderate-severe handicap)
-35% (-23 points)
Vertigo Attack Frequency4 attacks/month
-50% (-2 attacks/month)
Berg Balance Scale (BBS) Score42/56 points (impaired balance)
+14% (+6 points)
Dynamic Gait Index (DGI) Score18/24 points (impaired dynamic balance)
+17% (+3 points)
Secondary Benefits
Visual Analog Scale (VAS) for Dizziness Severity7/10 (severe dizziness)
-35% (-2.5 points)
Activities-specific Balance Confidence (ABC) Scale Score50/100 (low confidence)
+25% (+13 points)
Hospital Anxiety and Depression Scale (HADS) - Anxiety Subscale Score12/21 points (mild anxiety)
-20% (-2 points)
Common Side Effects
Temporary increase in dizziness
+10%
Fatigue
+5%

Clinical Trial Phases:

Phase 4