Expert opinions regarding neuro-microcirculatory, vestibular and labyrinthine dynamics in benign paroxysmal positional vertigo

Rajesh Benny

doi:10.18203/2320-6012.ijrms20220541

Authors

Rajesh Benny Department of Neurology, Fortis Hospital, Mumbai, Maharashtra, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20220541

Keywords:

Betahistine, Epley maneuver, Dizziness, Vestibular compensation

Abstract

Benign paroxysmal positional vertigo (BPPV) is a common vestibular disorder and a leading cause of peripheral vertigo in adults. The current treatment with repositioning maneuvers still leaves some residual dizziness in a significant proportion of patients with BPPV. The role of neuro-microcirculatory, vestibular, and labyrinthine dynamics needs to be evaluated. Eighty leading neurologists and otolaryngologists from across India participated in advisory board meetings to debate on altered neuro-microcirculatory, vestibular, and labyrinthine dynamics in BPPV. Betahistine when used in conjunction with Epley maneuver was considered to be a safe treatment. Betahistine can be used as monotherapy in patients with BPPV who are deemed unfit to undergo canalolith repositioning maneuvers. Betahistine provides short-term relief from acute symptoms associated with BPPV by improving microcirculation in the labyrinth and improves vestibular compensation, thereby providing long-term benefit. Betahistine also improves outcomes in combination with canalolith repositioning maneuvers. Experts unanimously agreed upon the role of betahistine in providing better vestibular health and in-turn, recovery from vertigo.

Metrics

Metrics Loading ...

References

Wu P, Cao W, Hu T, Li H. Effects of vestibular rehabilitation, with or without betahistine, on managing residual dizziness after successful repositioning manoeuvres in patients with benign paroxysmal positional vertigo: a protocol for a randomised controlled trial. BMJ Open. 2019;9:e026711.

Kameswaran M, Pujari S, Singh J, Basumatary LJ, Sarda K, Pore R. Clinicoetiological pattern and pharmacotherapy practices in patients with new onset vertigo: findings from a prospective multicenter registry in India. Int J Otolaryngol Head Neck Surg. 2017;3:404-13.

Tari AD, Kumar S. The effect of postural stability exercises in benign paroxysmal positional vertigo: Pre-post-experimental study. Physiotherapy. 2017;11:66-70.

Wada M, Naganuma H, Tokumasu K, Hashimoto S, Ito A, Okamoto M. Arteriosclerotic changes as background factors in patients with peripheral vestibular disorders. Int Tinnitus J. 2008;14:131-4.

Agrup C, Gleeson M, Rudge P. The inner ear and the neurologist. J Neurol Neurosurg Psychiatry 2007;78:114-22.

Bhattacharyya N, Baugh RF, Orvidas L, Barrs D, Bronston L, Cass S et al. Clinical practice guideline: benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg. 2008;139:S47-81.

Yetiser S. Review of the pathology underlying benign paroxysmal positional vertigo. J Int Med Res 2020;48:300060519892370.

Şahin E, Deveci I, Dinç ME, Özker BY, Biçer C, Erel O. Oxidative status in patients with benign paroxysmal positional vertigo. J Int Adv Otol. 2018;4:99-303.

Epley JM. The canalith repositioning procedure for treatment of benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg. 1992;107:399-404.

Giommetti G, Lapenna R, Panichi R, Mobaraki PD, Longari F, Ricci G et al. Residual dizziness after successful repositioning maneuver for idiopathic benign paroxysmal positional vertigo: A review. Audiol Res. 2017;7:178.

Parfenov VA, Golyk VA, Matsnev EI, Morozova SV, Melnikov OA, Antonenko LM et al. Effectiveness of betahistine (48 mg/day) in patients with vestibular vertigo during routine practice: The VIRTUOSO study. PLoS One. 2017;12:e0174114.

Stambolieva K, Angov G. Effect of treatment with betahistine dihydrochloride on the postural stability in patients with different duration of benign paroxysmal positional vertigo. Int Tinnitus J. 2010;16:32-36.

Lacour M, Sterkers O. Histamine and betahistine in the treatment of vertigo: elucidation of mechanisms of action. CNS Drugs 2001;15:853-70.

Berisavac II, Pavlović AM, Trajković JJZ, Šternić NMC, Bumbaširević LJB. Drug treatment of vertigo in neurological disorders. Neurol India. 2015;63:933-9.

Biswas A. Betahistine. Indian J Otolaryngol Head Neck Surg. 1997;49:179-87.

Laurikainen E, Miller JM, Nuttall AL, Quirk WS. The vascular mechanism of action of betahistine in the inner ear of the guinea pig. Eur Arch Otorhinolaryngol. 1998;255:119-23.

Laurikainen E, Miller JF, Pyykkö I. Betahistine effects on cochlear blood flow: From the laboratory to the clinic. Acta Otolaryngol Suppl. 2000;544:5-7.

Suga F, Snow JB. Cochlear blood flow in response to vasodilating drugs and some related agents. Laryngoscope. 1969;79:1956-79.

Della Pepa C, Guidetti G, Eandi M. Betahistine in the treatment of vertiginous syndromes: a meta-analysis. Acta Otorhinolaryngol Ital. 2006;26:208-15.

Kaur J, Shamanna K. Management of benign paroxysmal positional vertigo: a comparative study between Epleys manoeuvre and betahistine. Int Tinnitus J. 2017;21:30-4.

Cavaliere M, Mottola G, Iemma M. Benign paroxysmal positional vertigo: a study of two manoeuvres with and without betahistine. Acta Otorhinolaryngol Ital. 2005;25:107-12.

Guneri EA, Kustutan O. The effects of betahistine in addition to epley maneuver in posterior canal benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg. 2012;146:104-8.