High dose betahistine as effective as, but slower acting compared to intratympanic dexamethasone in intractable Meniere’s disease
Reviewed by Rohit Verma

The management of intractable Meniere’s disease poses a complex conundrum to otolaryngologists. The focus of treatment is decreasing the severity and frequency of vertigo and tinnitus whilst trying to preserve hearing. Betahistine has been used for many years in the treatment of Meniere’s disease often in combination with dietary modification and/or diuretics. In recent years, intratympanic (IT) dexamethasone has gained popularity although there is no current consensus on a protocol for IT administration. Betahistine at high doses (144mg/day) has also been demonstrated to be effective. In this randomised study, 66 patients received either IT dexamethasone and placebo tablet or IT saline and betahistine. Tinnitus Handicap Inventory (THI) and Dizziness Handicap Inventory (DHI) were evaluated for every patient in addition to audiolological assessment. The IT injections were given once a day for three days. IT dexamethasone (1ml of 4mg/ml) was administered using a 22 gauge needle with the patient supine and affected ear facing upward for 30 minutes. Betahistine was given at 48mg TDS. Patients were followed up over one year and frequency of vertigo symptoms assessed every three months with telephone calls to check compliance and side-effect profiles. In total 14/33 patients receiving IT dexamethasone reported complete control of symptoms and only one no control. High dose betahistine resulted in 12/33 reporting complete symptom control with no control in two patients. There were no significant differences between the groups in post treatment audiological assessments. Side-effects for betahistine did not cause any patient to leave the study. This study suggests that whilst there is a current trend for intratympanic dexamethasone to treat intractable Meniere’s disease, it may still be worth trialing higher doses of betahistine before IT dexamethasone. However, IT dexamthasone works within three days whilst betahistine took three months to take effect, supporting its use in disabling vertigo spells.

Intratympanic dexamethasone versus high dosage of betahistine in the treatment of intractable unilateral Meniere disease.
Albu S, Chirtes F, Trabalzini F, et al.
AMERICAN JOURNAL OF OTOLARYNGOLOGY-HEAD AND NECK MEDICINE AND SURGERY
2015;36(2):205-9.