Management of Menière's Disease with Betahistine

Diagnostic Criteria and Indications

The American Academy of Otolaryngology-Head and Neck Surgery recommends betahistine as maintenance therapy to reduce symptoms or prevent attacks in patients with Menière's disease who have been diagnosed with definite or probable Menière's disease 1, 2, 3, 4
Definite Menière's disease is characterized by 2 or more episodes of vertigo lasting 20 minutes to 12 hours AND fluctuating or nonfluctuating sensorineural hearing loss, tinnitus, or pressure in the affected ear, according to the American Academy of Otolaryngology-Head and Neck Surgery 1
Probable Menière's disease has the same symptoms but vertigo episodes may last up to 24 hours, as defined by the American Academy of Otolaryngology-Head and Neck Surgery 1
Betahistine should be considered as maintenance therapy to reduce frequency and severity of vertigo attacks in patients with Menière's disease, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 1, 2, 3, 4

The American Academy of Otolaryngology-Head and Neck Surgery advises against using betahistine in patients with pheochromocytoma, due to potential adverse effects 5
Betahistine should be used with caution in patients with asthma, history of peptic ulcer disease, as recommended by medical guidelines 5

The American Academy of Otolaryngology-Head and Neck Surgery recommends documenting resolution, improvement, or worsening of vertigo, tinnitus, and hearing loss in patients with Menière's disease 1, 2, 3, 4
Assessing changes in quality of life is also recommended for patients with Menière's disease, according to the American Academy of Otolaryngology-Head and Neck Surgery 1, 2, 3, 4
Consider obtaining follow-up audiograms to monitor hearing function in patients with Menière's disease, as suggested by the American Academy of Otolaryngology-Head and Neck Surgery 1, 2, 3, 4

The American Academy of Otolaryngology-Head and Neck Surgery recommends offering a limited course of vestibular suppressants for acute attacks of Menière's disease 1, 2, 3, 4
Diuretics may be offered as an alternative or in addition to betahistine for maintenance therapy in patients with Menière's disease, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 1, 2, 3, 4
Vestibular rehabilitation/physical therapy may be considered for patients who have failed less definitive therapy and have nonusable hearing, according to the American Academy of Otolaryngology-Head and Neck Surgery 1, 2, 3, 4

Patient preferences should be considered in treatment decisions, particularly when evidence for benefit is unclear, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 1, 2, 3, 4
Betahistine should not be used for benign paroxysmal positional vertigo (BPPV), as advised by medical guidelines 5