Therapeutic target
Improvement of the symptomatology
Therapy recommendations
Note: There is no proven causal (“cause-and-effect”) therapy.
Therapeutic measures occur in the following stages:
- Drug therapy (= 1st stage of therapy):
- In seizure: dimenhydrinate (antivertiginosa (drug used to treat vertigo)/antihistamines (agents that reverse the effects of the body’s own substance histamine).
- For prophylaxis (preventive aftercare): betahistine (antivertiginosa; discussion of efficacy: see below under “Further notes”), hydrochlorothiazide (HCT) (diuretics/draining drugs) if necessary, or low-salt diet to influence hydrops (“fluid stagnation” in the inner tube)Intratympanic glucocorticoids should improve inner ear function again and prevent further seizures.
- Local middle ear hypertension therapy (= 2nd stage of therapy; see “Further therapy” below).
- Saccotomy/opening of the saccus endolymphaticus (= 3rd stage of therapy; see “Surgical therapy” below).
- Elimination of the vestibular organ (neurectomy/separation of a peripheral nerve of the vestibulocochlear nerve; = 4th stage of therapy) by ototoxic drugs/medications that have a damaging effect on the ear: Gentamicin (12 mg per session) intratympanal acts ablative/”ablative”, “abolishing “Alternatively: transtympanal administration of glucocorticoids (no cochleo- and vestibulotoxicity/no toxicity concerning the organ of hearing (cochlea) as well as the organ of balance (vestibular system/vestibulum)).
See also under “Further therapy”.
Further notes
- Discussion of the efficacy of betahistine:
- A double-blind, placebo-controlled study of the efficacy of betahistine showed that it was not more effective than placebo at either low or high doses.
- The prospective, multinational, noncomparative observational study VIRTUOSO showed beneficial effects at a dosage of 48 mg/d in patients with vestibular vertigo in routine care
- The following additional studies support the effectiveness of betahistine: Chochrane analysis and a meta-analysis.
- A systematic review of 19 studies showed a clear benefit of diuretics on vertigo symptoms in 15 studies (79%). Only eight studies (42%) found an objectively measurable improvement.
- The number of vertigo attacks in patients with unilateral Meniere’s disease was reduced as well by intratympanic steroid injections as by injections of the aminoglycoside gentamycin within the last six months of a two-year follow-up. If the patient – a musician, for example – is dependent on excellent hearing, intratympanic steroid injections should be preferred as a treatment modality.
