Treatments for Meniere’s disease: Fact, Fiction or Biological Plausibility? Part II

A quick review of past studies regarding treatment for Meniere’s disease.

Back in 1977, a 25-year review of 834 papers related to treatments for Meniere’s disease was published by Nicholas Torok {{1}}[[1]]Torok N: Old and new in Meniere disease. Laryngoscope 87:1870, 1977[[1]]. His conclusion was that, whatever treatment was attempted, or if no treatment was attempted, between 60% and 80% of patients reported improvement in symptoms. A more recent literature review in 1991 by Ruckenstein et al. {{2}}[[2]]Ruckenstein MJ, Rutka JA and Hawke M (1991). “The treatment of Meniere’s disease: Torok revisited.” Laryngoscope 101(2): 211-8.[[2]] also concluded that no one treatment was clearly better than another, and that there were no well controlled studies demonstrating clear benefit from any specific medical treatment for the symptoms of Meniere’s disease. Dr. Tim Hain has a website I would recommend to anyone wanting to explore this topic further.

Let’s take a walk down the path of evidence supporting (or not) the treatments discussed in last week’s articles. We will focus this week on Betahistine, used by 94% of physicians in the United Kingdom. Also dispensed under the brand name SERC, Betahistine is primarily a histamine. Phillips and Johnson {{3}}[[3]]http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2291377/[[3]] state that “it seems a contradiction to treat patients with a histamine for a disease that is also relieved by systemic antihistamines” (presumably Meclizine/Antivert, which is most commonly used for treatment of acute vertigo and nausea). They also point out that there no studies providing convincing evidence that Betahistine makes much difference. The Food and Drug Administration has been up and down on this medication (currently down). The fact that Betahistine is not FDA approved does not make it illegal. It can be obtained in the United States by compounding agencies found at some pharmacies.

Next week we will review what we know about the benefits and risks of a low salt, diet which is commonly the first line of treatment for patients with suspected Meniere’s disease.

For anyone interested and able to understand (that would not include me… Interested? Yes… Understand? No) I have attached below the pharmacodynamics information on Betahistine listed on DrugBank.CA

“Betahistine primarily acts as a histamine H1-agonist with 0.07 times the activity of histamine. Stimulating the H1-receptors in the inner ear causes a vasodilatory effect and increased permeability in the blood vessels which results in reduced endolymphatic pressure. Betahistine is believed to act by reducing the asymmetrical functioning of sensory vestibular organs as well as by increasing vestibulocochlear blood flow. Doing so aids in decreasing symptoms of vertigo and balance disorders. Betahistine also acts as a histamine H3-receptor antagonist which causes an increased output of histamine from histaminergic nerve endings which can further increase the direct H1-agonist activity. Furthermore, H3-receptor antagonism increases the levels of neurotransmitters such as serotonin in the brainstem, which inhibits the activity of vestibular nuclei, helping to restore proper balance and decrease in vertigo symptoms.”

 

About Alan Desmond

Dr. Alan Desmond is the director of the Balance Disorders Program at Wake Forest Baptist Health Center, and holds an adjunct assistant professor faculty position at the Wake Forest School of Medicine. In 2015, he received the Presidents Award from the American Academy of Audiology.