Maternal Meniere's disease

Ménière's disease is a pathology of the inner ear, of unknown etiology, that presents with recurrent attacks of vertigo, sensorineural hearing loss, ear fullness, and tinnitus. ^{(Bianchi 2015, NIH 2010)}
The disease itself does not contraindicate breastfeeding. Treatment is symptomatic and, for the most part, is compatible with lactation. Most of the treatments used have a low level of evidence. ^{(Magnan 2018, Casani 2018, Guía ACORL 2015)}

Treatments for acute crisis:

• Anticholinergics: scopolamine, glycopyrrolate
• Antihistamines: diphenhydramine, dimenhydrinate, meclizine, promethazine
• Dopamine antagonists, phenothiazines: sulpiride, domperidone, benzamides, thiethylperazine
• Benzodiazepines: diazepam, clonazepam, lorazepam, oxazepam
• Monoamines: ephedrine, amphetamine
• Corticosteroids; betamethasone, prednisone

Maintenance treatment:

• Diet low in salt, reduce the consumption of caffeine, alcohol and tobacco and reduce stress, all compatible with breastfeeding.
• Betahistine
• Diuretics: hydrochlorothiazide, furosemide, chlorthalidone, acetazolamide
• Intratympanic administration of Gentamicin and/or Corticosteroids (dexamethasone).
• Others: flunarizine, cinnarizine, nimodipine, hydralazine, trimetazidine, piracetam
• Endolymphatic sac or nerve surgery, cognitive therapy, positive pressure pulses
• Alternative medicine: acupuncture, acupressure, tai chi, ginkgo biloba, niacin, ginger