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

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About R.D. Gardi Medical College

Ujjain has been a seat of learning since time immemorial. Here Lord Krishna underwent his education at Sant Sandipani’s Ashram situated on the banks of river Kshipra. Vikram University in Ujjain was established as early as in 1954. Presently the city has number of schools and colleges including many professional colleges.

A dedicated team of trustees visualized and launched the Medical College project in 1997 and have succeeded in establishing R.D. Gardi Medical College (RDGMC), the first private Medical College of Madhya Pradesh in the year 2001. RDGMC is recognized by the Medical Council of India and Ministry of Health & Family Welfare, Govt. of India. We run under-graduate and post-graduate courses in eighteen subjects since 2009 including PG degree in Dermatology, Tuberculosis and Respiratory Diseases & Psychiatry conducting for the first time in Madhya Pradesh.

For Medical College with high academic standards and providing excellent medical education, a good modern hospital equipped with sophisticated diagnostic & therapeutic equipment is a pre-requisite. We commissioned a modern hospital, The Ujjain Charitable Trust Hospital in 1992 with sophisticated diagnostic and therapeutic equipment twenty-four years back. The hospital is having 400 beds. We also have another 800-bedded world class hospital in the Medical College Campus where all the services are provided free. We are proud that we are providing, as envisaged standard medical education to the students. Nine batches of Undergraduate and five batches of Post Graduate courses have already been passed out with flying colours.

Our aim is to provide best medical education to students, expose them to renowned national and international faculty, motivate them for research and make them competent clinicians who can meet the challenge of treatment in the remotest village of India as well as the most advanced hospital anywhere in the world.