Innovations in conservative and surgical therapy for Ménière's disease-narrative review

Ménière's disease (MD) is an inner ear disorder of poorly understood etiology, and its management remains symptomatic. This review presents novel therapeutic approaches to control vertigo, improve audiological function, and enhance patient outcomes in MD. The literature was reviewed to explore conservative and surgical methods under current investigation. Recent advances in pharmacological therapy target oxidative stress, immune-mediated pathways, and neuromodulatory mechanisms. Clinical trial reports evaluating the efficacy of new oral treatment-ebselen were included. Preliminary report describing treating patients with MD and migaine with rimegepant was analyzed. Novel strategies to improve betahistine bioavailability were also reviewed. Authors reported modifications to intratympanic steroid therapy with OTO-104 and SPT-2101 (sustained-release intratympanic dexamethasone hydrogel). Contemporary surgical approaches increasingly aim to preserve hearing and, when feasible, partial vestibular function. Among surgical techniques, endolymphatic sac surgery with various modifications, endolymphatic duct blockage, canal plugging, and transcanal neurectomy were analyzed. Advances in pharmacological and surgical strategies offer new options for MD symptom control, but their effectiveness remains to be confirmed in larger, long-term trials. At the same time, these innovative therapeutic approaches provide valuable insights into the underlying pathophysiological mechanisms of the disease and may stimulate further research into its etiology. A better understanding of disease etiology is essential for developing causal treatments.