China
Africa
Explore chapters and articles related to this topic
Vestibular Disorders and Rehabilitation
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
Dietary restrictions on sodium and caffeine are traditionally advised, although not proven. There is mixed evidence for the use of betahistine in MD, although it does have a favourable safety profile and is well tolerated, so it is often used. A Cochrane review concluded that there is no evidence to demonstrate the effectiveness of positive transtympanic low-pressure therapy. Diuretics have also been recommended, although the evidence base is weak and there is potential for significant unwanted effects in relation to salt homeostasis and renal function.
Common otology viva topics
Published in Joseph Manjaly, Peter Kullar, Advanced ENT Training, 2019
Betahistine: A histamine H3 receptor antagonist and weak H1 agonist. Postulated to work by reducing endolymphatic hydrops through improvements in microcirculation. The drug is generally well tolerated and is effective in some patients however the BEMED trial found no difference in symptom control between betahistine and placebo groups.
Acute vertigo
Published in S. Musheer Hussain, Paul White, Kim W Ah-See, Patrick Spielmann, Mary-Louise Montague, ENT Head & Neck Emergencies, 2018
Rahul Kanegaonkar, Max Whittaker
Medical treatment in the form of lifestyle changes (e.g. adopting a low-salt diet; avoiding alcohol, caffeine and stress) and medication are effective in controlling vertigo in approximately 85 per cent of patients. Pharmacological agents include betahistine, which, although it has no clinically proven benefit, is thought to prevent symptoms by vasodilatation in the inner ear with very few side-effects. Thiazide diuretics are thought to reduce the volume of the endolymph compartment, and antiemetic agents such as prochlorperazine are reserved for acute spells.
Progression of endolymphatic hydrops and vertigo during treatment in Meniere’s disease
Published in Acta Oto-Laryngologica, 2022
Yue Niu, Wei Chen, Mengyan Lin, Yan Sha
However, there were few studies on the progression of EH in the long-term course of MD. All patients in this study received conventional medical therapy. The mechanism of action of diuretics in MD is to alter the electrolyte balance in the endolymph and to decrease the volume and pressure of the endolymph by increasing its drainage or reducing its production [12]. The pharmacology of Betahistine remains unclear. It may affect the hydrodynamics of the inner ear by improving circulation in the stria vascularis of the cochlea and improve vestibular hair cell function by acting on the precapillary sphincters and reducing excessive endolymph pressure [13]. Intratympanic steroid injection is also considered to be an effective method to control refractory MD. A previous animal study showed that steroids can induce upregulation of inflammatory cytokine genes and ion homeostasis genes in the inner ear [14]. It can also reduce EH by regulating the expression of aquaporin [15]. Among the 42 patients in this study, the degree of EH increased in 18 cases and was relieved in three cases. A study in 2017 which followed patients with MD also showed that patient’s EH developed longitudinally even after treatment [16]. In this study, patients with vestibular hydrops progression were more than those with cochlear hydrops. The reason may be that in the evaluation method of EHs adopted in this study, the grading of vestibular hydrops was more detailed than that of cochlear hydrops.
Intratympanal administration of lidocaine in the management of Ménière’s Disease
Published in Acta Oto-Laryngologica, 2021
Mattis Bertlich, Friedrich Ihler, Jennifer Lee Spiegel, Martin Canis, Bernhard G. Weiss
Therapy approaches for MD are diverse and range from dietary restrictions [4], surgical options [5], to intratympanic steroids [6] and diuretics [7]. The main therapeutic aim is to reduce the number of attacks taking place. The most common approach in Europe has, until recently, been oral application of betahistine, a histamine-analogue that increases cochlear microcirculation in a dose-dependent manner [8]. It is supposed to decrease the endolymphatic hydrops by increased transportation of the excess fluid. However, by a recent multicenter study which was conducted prospectively in a double-blind, placebo-controlled manner, the efficacy of betahistine in MD was called into question [9].
Betahistine prevents development of endolymphatic hydrops in a mouse model of insulin resistance and diabetes
Published in Acta Oto-Laryngologica, 2023
Ann-Ki Pålbrink, René in ’t Zandt, Måns Magnusson, Eva Degerman
Insulin resistance and type 2 diabetes are frequent companions to weight gain and adiposity. Weight gain and adiposity are also frequent in patients treated with anti-psychotic drugs [15]. In the latter case, betahistine, a histaminergic H1 receptor (Gq) agonist and H3 receptor (Gi) antagonist, has been used as a prevention [15]. The histaminergic system, including H1 and H3 receptors, has indeed been shown to be a potential target for the treatment of obesity and diabetes [16]. Betahistine, has also been extensively used in the symptomatic treatment of vestibular disorders such as Menieres disease, a hydropic inner ear disease [17].