What is the second-line therapy for refractory Menière’s disease?

• A. Prednisone therapy
• B. Antihistamines
• C. Methylprednisolone
• D. Diuretics

Answer: (C)

When vertigo from Menière’s disease persists despite initial measures like a low-salt diet and diuretic therapy, the aim shifts to directly reducing the inner ear swelling and inflammation. Delivering a corticosteroid right to the middle ear—typically methylprednisolone—achieves high local concentrations in the labyrinth with fewer systemic side effects. This intratympanic steroid approach can lessen the frequency of vertigo attacks and may help with hearing in some patients.

Systemic prednisone is still a steroid option, but the key second-line strategy favored here is targeted steroid therapy to the inner ear. Diuretics are usually used first to control endolymphatic hydrops, and antihistamines don’t address the underlying fluid-electrolyte imbalance.