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Consensus conference on the use of betahistine in Ménière's disease: statements on the efficacy in the intercritical phase.
Source publication
Ménière's disease is a disorder of the inner ear that causes vertigo, tinnitus, fullness and hearing loss. Although several treatments are available, the success rate is reported to be around 70%, similar to placebo. Betahistine, a weak H1 receptor agonist and an effective H3 receptor antagonist, is frequently prescribed for Ménière's disease, espe...
Context in source publication
Context 1
... entire panel of 78 Italian experts in vestibular disorders participated in the CC and evaluated the use and efficacy of betahistine in MD. With regards to prevention of vertigo spells, betahistine was considered useful (87% agreement) and a first-choice therapy between attacks (71% agreement, Fig. 2). However, betahistine was considered less effective during the acute phase of the disease and useful only when associated with other drugs (77% agreement, Fig. 3). In the management of Tumarkin's otolithic crisis, the drug was not considered efficacious (85% agreement), and use- ful only if associated with other agents (74% ...
Citations
... Betahistine has been developed as a marketed drug and is commonly used to treat vertigo symptoms caused by different reasons [9]. For example, CASANI et al. 's study showed that Betahistine was used in the intercritical phase of Ménière's disease to reduce the number and severity of vertigo attacks [10]. Chen et al. reported that combined Betahistine and puerarin regimens were more effective in treating vertebrobasilar artery ischemic vertigo compared with other, conventional drugs; effectively alleviating the associated symptoms, including dizziness and increased average blood flow velocity within the vertebrobasilar arteries, without causing an increased number of serious side effects [11]. ...
Background
Betahistine is a clinical medication for the treatment of benign paroxysmal positional vertigo (BPPV). Otolin, a secreted glycoprotein with a C-terminal globular domain homologous to the immune complement C1q, has been identified as a biomarker for BPPV. However, the role of complement C1q/TNF-related proteins (CTRPs) with a C-terminal globular domain in BPPV is unclear, so we explored the change of CTRPs in betahistine treated BPPV.
Methods
We treated BPPV patients with Betahistine (12 mg/time, 3 times/day) for 4 weeks and observed the clinical efficacy and the expression of CTRP family members in BPPV patients. Then, we constructed a vertigo mice model of vestibular dysfunction with gentamicin (150 mg/Kg) and a BPPV model of Slc26a4 loop/loop mutant mice. Adenoviral vectors for CTRP expression vector and small interfering RNA were injected via the intratympanic injection into mice and detected the expression of CTRP family members, phosphorylation levels of ERK and AKT and the expression of PPARγ. In addition, we treated mice of vestibular dysfunction with Betahistine (10 mg/Kg) and/or ERK inhibitor of SCH772984 (12 mg/Kg) and/or and PPARγ antagonist GW9662 (1 mg/Kg) for 15 days, and evaluated the accuracy of air righting reflex, the time of contact righting reflex and the scores of head tilt and swimming behavior.
Results
After treatment with Betahistine, the residual dizziness duration and the score of the evaluation were reduced, and the expression of CTRP1, 3, 6, 9 and 12 were significantly increased in BPPV patients. We also found that Betahistine improved the accuracy of air righting reflex, reduced the time of contact righting reflex and the scores of head tilt and swimming behavior in gentamicin-treated mice and Slc26a4 loop/loop mutant mice. The expression levels of CTRP1, 3, 6, 9 and 12, phosphorylation levels of ERK and AKT, and PPARγ expression were significantly increased, and the scores of head tilt and swimming behavior were decreased in vestibular dysfunction mice with overexpression of CTRPs. Silencing CTRPs has the opposite effect. SCH772984 reversed the effect of Betahistine in mice with vestibular dysfunction.
Conclusion
Betahistine alleviates BPPV through inducing production of multiple CTRP family members and activating the ERK1/2-AKT/PPARy pathway.
... It turned out that the clinical efficacy of the OG was better than the CG, indicating that the use of betahistine hydrochloride tablets can improve the efficacy of VBI. In previous studies, we also found that betahistine hydrochloride tablets had excellent efficacy on diseases such as Meniere's disease and vestibular vertigo [18,19], which can also support the results of this experiment. Besides, we also found that there was no obvious difference in the clinical safety of both groups, which also demonstrates that the use of betahistine hydrochloride tablets has high safety and is worth popularizing in clinical use. ...
Objective:
To explore the clinical efficacy and safety of betahistine hydrochloride tablets in patients with vertebrobasilar insufficiency vertigo (VBIV).
Methods:
A total of 133 patients with vertigo caused by vertebrobasilar insufficiency treated in The First People's Hospital of Shangqiu City from March 2019 to August 2021 were selected and analyzed retrospectively. Among them, 63 patients treated with flunarizine tablets were seen as the control group (CG), and 70 with flunarizine tablets combined with betastine hydrochloride tablets were considered as the observation group (OG). The treatment efficacy and adverse reactions were compared, and the vertigo symptom score, quality of life and vertebrobasilar artery hemodynamics were observed before and after treatment.
Results:
The effective rate in the OG was higher than that of the CG (P<0.05), but there was no obvious difference in adverse reactions (P>0.05). Compared with the CG, the arterial hemodynamics and cerebral blood perfusion as well as SF-36 score were higher, while the scores of dizziness assessment rating scale (DARS) and dizziness handicap inventory (DHI) scale were lower in the OG (all P<0.05).
Conclusion:
Betahistine hydrochloride can effectively improve arterial hemodynamics and cerebral blood flow perfusion in vertebrobasilar insufficiency patients and enhance the clinical efficacy with high safety profile, which is worthy of wide application.
... 5 Medical treatment is often based on the use of antagonist histaminergic 30 molecules. 6 ...
Background and Objective
Meniere’s disease (MD) is an idiopathic peripheral pathology involving the acoustic apparatus. One of the most critical challenges in managing MD is intractable vertigo. In this context, the retrosigmoid vestibular neurectomy (RVN) has been described as a safe and effective technique to manage this symptom when resistant to first- and second-line treatments. In this article, the alternative treatment options, specific surgical anatomy, and relevant details to perform vestibular neurectomies for intractable MD are analyzed.
Methods
Relevant neurovascular landmarks, critical surgical steps, adequate indications, and potential pitfalls of the RVN were analyzed based on an illustrative clinical case of intractable MD.
Results
The illustrative case demonstrated how early recognition of the facial nerve and the vestibulo-cochlear plane is fundamental to performing RVN. This procedure is indicated in cases of resistant MD with pre-operative hearing integrity. Potential pitfalls of this technique are incomplete neurotomy, nerve regeneration, comorbidities in the contralateral ear, adverse anatomy, the possibility of non-otologic vertigo, and incomplete vestibular compensation.
Conclusions
Vestibular neurectomy represents a safe and effective technique in managing intractable MD resistant to medical treatment, allowing symptom control and hearing preservation. Nevertheless, detailed knowledge of surgical anatomy, as well as possible pitfalls, is of paramount importance to achieve a good outcome.
... The histopathological correlate, endolymphatic hydrops, is observed most frequently in the cochlea and the saccule, followed by the utricle and the semi-circular canals [23][24][25] . The diagnosis of MD relies upon clinical presentation and pure tone audiometry, which in the early stages of the disease shows low frequency hearing loss in a "rising configuration" that later progresses to a flat hearing loss of moderate severity [26][27][28][29] . Current standard vestibular testing consists of caloric stimulation of both ears using nystagmography to evaluate the ear's functionality. ...
Plain-language-summary
Vestibular evoked myogenic potentials (VEMPs) are increasingly used for different pathologies with new clinical insights. Although the study of otolithic function selectively in both its saccular (cervical VEMPs) and utricular (ocular VEMPs) parts does not represent a recent achievement, the clinical utility of this tool is still emerging. The aim of the present report is to define advances in application of VEMPs in diagnosis and clinical study of vestibular neuritis, Ménière’s disease and benign paroxysmal positional vertigo. To perform a systematic review of the literature, three appropriate strings were run in PubMed to retrieve dedicated articles. A double cross-check was performed on citations and two independent investigators independently reviewed all full-text articles and performed a comprehensive quality assessment. Of 140 articles identified, 26 articles were included, comprising a total of 1,181 patients affected by vestibular neuritis (296 subjects), Ménière’s disease (378 patients) and benign paroxysmal positional vertigo (507 patients). Overall, the use of both cVEMP and oVEMP appeared particularly useful in improving the topographic diagnosis of vestibular neuritis. Most (n = 8) of the studies dedicated to Ménière’s disease and benign paroxysmal positional vertigo (10 overall) also reported significantly abnormal VEMP values compared to healthy controls. Although further reports will be necessary to better define normal threshold levels of VEMPs for each pathology, our review suggests that VEMPs may represent a useful aid in improving the diagnostic accuracy for these three common vestibular pathologies.
Despite the high success rate of canalith repositioning maneuvers (CRMs) in the treatment of benign paroxysmal positional vertigo (BPPV), a growing number of patients report residual dizziness symptoms that may last for a significant time. Although the majority of BPPV cases can be explained by canalolithiasis, the etiology is complex. Consideration of the individual patient’s history and underlying pathophysiology of BPPV may offer the potential for treatment approaches supplementary to CRMs, as well as a promising alternative for patients in whom CRMs are contraindicated. This article provides a summary of the possible underlying causes of BPPV and residual dizziness, along with suggestions for potential management options that may be considered to relieve the burden of residual symptoms.
Menière’s disease (MD) is an episodic vertigo syndrome typically combining vestibular and cochlear symptoms and signs. It is the second most frequent cause of peripheral and known as an inner ear disease since 1861 (for Ref., see Lustig and Lalwani 1997). The pathognomonic histopathological finding is endolymphatic hydrops. However, the etiology and pathophysiology of MD are, despite many studies, so far not fully understood (for references, see Nakashima et al. 2016). The current diagnostic criteria for MD are as follows (adapted from Lopez-Escamez et al. 2015) (► Box 10.1):
Introduction:
Ménière's disease (MD) is an inner ear disorder, characterized by vertiginous attacks, fluctuating sensorineural hearing loss, tinnitus, and a feeling of ear fullness. Endolymphatic hydrops has been proven as the underlying pathology. Frequently, psychopathologies accompany the disease. The aim of this study was to investigate the correlation of anxiety and depression with demographic, clinical, and audio-vestibular findings in MD patients.
Methods:
The study included 40 consecutive unilateral MD patients. Demographic data (age, sex, education, employment, and marital status), clinical variables of drop attacks, the duration, frequency and severity of vertigo attacks, and tinnitus disturbance levels were recorded. Hearing threshold levels were graded between 1 and 4. Vestibulometric variables were taken as the presence of saccades and vestibulo-ocular reflex (VOR) gain deficits in the video head impulse tests (vHIT) and canal paresis in bithermal caloric tests. Becks's depression and anxiety scales were used for psychometric evaluations and graded by 4 and 5 from normal to severe and normal to very severe, respectively.
Results:
The median age of the patients was 48.94 years, and the numbers of both sexes were almost equal (male/female = 19/21). All patients reported at least one vertigo attacks within the last year. The duration of attacks was most commonly (62.5%) 1-3 h, ranging from <1 h to 17 h. Most attacks were graded as mild (67.5%), and the frequency was 2-3 episodes per year in 22 (55%) patients. The number of attacks within the last year was 1-12. Three patients reported having drop attacks. Hearing loss in the affected ear was moderate/moderately severe in 20 (50%) patients. Thirty-seven (92.5%) patients had complaints of tinnitus. In vHIT, saccades and VOR gain deficits were found in 33 (82.5%) and 11 (27.5%) patients, respectively. Canal paresis was present in 18 (45%) patients. The depression and anxiety rates were 35% and 90%, respectively. Depression scores were correlated with education, marital status, and the presence of saccades. Anxiety was correlated only with tinnitus severity and VOR gain deficits. Depression and anxiety were also correlated.
Conclusion:
Vertigo appears to be more intrusive than the other MD symptoms, and a higher correlation with anxiety than depression was demonstrated in this cohort. However, depression was seen less among married and educated patients, suggesting the role of coping capability, and had more pronounced clinical/vestibulometric correlates. Overall, these results indicated that it is mainly the severity of organic/physiological pathology which determines the degree of depression and anxiety in MD rather than vice versa.
Objective
This study aimed to evaluate the benefits of betahistine or vestibular rehabilitation (Tetrax biofeedback) on the quality of life and fall risk in patients with Ménière's disease.
Methods
Sixty-six patients with Ménière's disease were randomly divided into three groups: betahistine, Tetrax and control groups. Patients’ Dizziness Handicap Index and Tetrax fall index scores were obtained before and after treatment.
Results
Patients in the betahistine and Tetrax groups showed significant improvements in Dizziness Handicap Index and fall index scores after treatment versus before treatment ( p < 0.05). The improvements in the Tetrax group were significantly greater than those in the betahistine group ( p < 0.05).
Conclusions
Betahistine and vestibular rehabilitation (Tetrax biofeedback) improve the quality of life and reduce the risk of falling in patients with Ménière's disease. Vestibular rehabilitation (Tetrax biofeedback) is an effective management method for Ménière's disease.
