Meniere's disease is recognized as the idiopathic form of recurrent inner ear disease with the triad of fluctuating hearing loss, tinnitus and vertigo (1). There is no generally accepted tratment strategy for the disease. Betahistine dihydrochloride is recommended as first choice medical treatment and in case of failure in medical treatment and if hearing is worth saving, endolymphatic shunt surgery can be employed (2). I am a 36 year-old-pediatric oncologist and I have been followed with the diagnosis of Meniere's disease for 13 years. At the time of diagnosis I had serious vertigo attacks lasting 4-24 hours, tinnitus and bilateral hearing loss at low frequencies. After 6 months treatment of betahistine dihydrochloride and low-salt diet, the hearing loss was relieved. For 9 years I have experienced 1-2 vertigo attacks per year which were controlled with diphenhydramine and diuretics in acute attack and betahistine dihydrochloride three 16 mg at least 3 months.
For the last four years I have started myself a schedule consisting of betahistine dihydrochloride 8 mg/day resembling metronomic therapy which is a well-known practice in cancer treatment. I have experienced no vertigo attacks, nor have tinnitus or hearing difficulty for 4 years. All audiometric test results made once a year were normal during this period. No side effects developed related with the medication. Betahistine dihydrochloride is an orally administered, centrally acting histamine H1 receptor agonist with partial H3 antagonistic activity. It was clinically studied and is still used mainly as a vasodilator for the treatment of Meniere's disease (3). Its proposed mode of action is to cause vasodilation in ischemic areas of the stria vascularis and dark cells in the areas implicated in the pathogenesis of Meniere's disease (4). Strupp et al. (5) have found that the number of attacks after 12 months was significantly lower in the high dosage group (48 mg tid, n=62) than in the low dosage group (16 mg tid, n=21, 24 mg, n=29) with betahistine dihydrochloride therapy. Taking the medication in a metronomic fashion may regulate the circulation in affected areas continuously. No serious adverse effects was reported with long-term or high dose administration of betahistine dihydrochloride. Prospective clinical studies with adequate numbers of patients will reveal the efficiency of this metronomic therapy with continuous low-dose betahistine dihydrochloride in treatment of Menière's disease.
References
1. Minor LB, Schessel DA, Carey JP. Ménière's disease. Curr Opin Neurol. 2004 Feb;17(1):9-16. View Abstract
2. Westhofen M. [Article in German] [Menière's disease : evidence and controversies] HNO. 2009 May;57(5):446-54. View Abstract
3. Barak N. Betahistine: what's new on the agenda? Expert Opin Investig Drugs. 2008 May;17(5):795-804. View Abstract
4. Phillips JS, Prinsley PR. Prescribing practices for Betahistine. Br J Clin Pharmacol. 2008 Apr;65(4):470-1. Epub 2008 Feb 12. View Abstract
5. Strupp M, Hupert D, Frenzel C, Wagner J, Hahn A, Jahn K, Zingler VC, Mansmann U, Brandt T. Long-term prophylactic treatment of attacks of vertigo in Menière's disease--comparison of a high with a low dosage of betahistine in an open trial. Acta Otolaryngol. 2008 May;128(5):520-4. View Abstract
Serhan Kupeli
Chief of Pediatric Oncology Unit
Diyarbakir Children's Diseases Hospital
Diyarbakir, Turkey
