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Cheng PC, Wu PH, Chang CM, Lo WC, Liao LJ, Young YH, Cheng PW. Effect of long-term betahistine treatment on the clinical outcomes of patients with cochlear Meniere's disease. Acta Otolaryngol 2024:1-7. [PMID: 39008429 DOI: 10.1080/00016489.2024.2377160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 06/28/2024] [Indexed: 07/17/2024]
Abstract
BACKGROUND Many studies have discussed the betahistine treatment for Meniere's disease (MD). However, regarding cochlear MD, there is no consensus on the long-term betahistine treatment. AIMS/OBJECTIVES This study aims to investigate the relationship between the betahistine treatment duration in patients with cochlear MD and their clinical outcomes. MATERIAL AND METHODS We enrolled 78 patients with 96 ears who were diagnosed with cochlear MD and received the treatment for more than 6 months. Outcomes included the hearing status, frequency of acute hearing loss attack, and whether the disease progressed to MD. Clinical characteristics including age, sex, side of affected ear, treatment duration of betahistine and trichlormethiazide, and pre-treatment hearing level was recorded from medical charts. RESULTS Comparing the clinical characteristics by outcomes, the average betahistine treatment duration was the independent factor for hearing status of four-tone average (p = 0.01) and low-tone average (p = 0.03). Patients with average betahistine treatment duration of at least 277 days per year had higher odds ratio for improvement of the hearing status of four-tone and low-tone average. CONCLUSIONS For patients with cochlear MD, regular and long-term betahistine treatment can benefit their hearing outcome in the low- and medium-frequency.
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Affiliation(s)
- Ping-Chia Cheng
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Department of Biomedical Engineering, National Yang-Ming University, Taipei, Taiwan
| | - Po-Hsuan Wu
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Department of Electrical Engineering, Yuan Ze University, Taoyuan, Taiwan
| | - Chih-Ming Chang
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Department of Biomedical Engineering, National Yang-Ming University, Taipei, Taiwan
| | - Wu-Chia Lo
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Graduate Institute of Medicine, Yuan Ze University, Taoyuan, Taiwan
| | - Li-Jen Liao
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Yi-Ho Young
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Po-Wen Cheng
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
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Özgirgin ON, Kingma H, Manzari L, Lacour M. Residual dizziness after BPPV management: exploring pathophysiology and treatment beyond canalith repositioning maneuvers. Front Neurol 2024; 15:1382196. [PMID: 38854956 PMCID: PMC11157684 DOI: 10.3389/fneur.2024.1382196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 04/22/2024] [Indexed: 06/11/2024] Open
Abstract
Despite the high success rate of canalith repositioning maneuvers (CRMs) in the treatment of benign paroxysmal positional vertigo (BPPV), a growing number of patients report residual dizziness symptoms that may last for a significant time. Although the majority of BPPV cases can be explained by canalolithiasis, the etiology is complex. Consideration of the individual patient's history and underlying pathophysiology of BPPV may offer the potential for treatment approaches supplementary to CRMs, as well as a promising alternative for patients in whom CRMs are contraindicated. This article provides a summary of the possible underlying causes of BPPV and residual dizziness, along with suggestions for potential management options that may be considered to relieve the burden of residual symptoms.
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Affiliation(s)
| | - Herman Kingma
- Faculty of Medicine, Aalborg University, Aalborg, Denmark
- Maastricht University Medical Center, Maastricht, Limburg, Netherlands
| | - Leonardo Manzari
- Vestibology Science, MSA ENT Academy Center, Cassino, Lazio, Italy
| | - Michel Lacour
- Aix-Marseille Université, Neurosciences Department, Marseille, France
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3
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Sarı E, Nteli Chatzioglou G, Temirbekov D, Aliyeva A, Öztürk A, Gürses IA. The variations of osseous structure of the ınternal acoustic canal: an anatomical study. Braz J Otorhinolaryngol 2024; 90:101414. [PMID: 38492307 PMCID: PMC10955313 DOI: 10.1016/j.bjorl.2024.101414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 02/10/2024] [Indexed: 03/18/2024] Open
Abstract
OBJECTIVES The internal acoustic meatus is an osseous canal that connects the inner ear to the posterior cranial fossa. It is located in the petrous portion of the temporal bone. A thin cribriform osseous plate known as the fundus is situated at the lateral end of the canal. This study assesses the structural and numerical variations of the fundus formations. METHODS Fifty-four temporal bones of unknown gender and age were examined with the surgical microscope. RESULTS The temporal bones analyzed were 46.2% right-sided and 53.7% left-sided. Only one temporal bone had two parallel transverse crests, while three had a single anterior crest that split into two branches posteriorly. The number of foramina at the transverse crest varied, with 29.6% having none, 48.1% having a single foramen, and 22.2% having several foramina. An anterior crest structure was seen in 53.7% of the temporal bones, with 5% having a slightly constricted entry to the facial canal. In cases with a single nerve foramen, 48.1% had one, while 51.8% had more than one, including examples with three or four foramina. A crest was found between the foramina of the single nerve in 7% of patients. Furthermore, a crest between the saccular nerve foramen and the high fiber foramina was seen in 25.9% of cases, and 5% had two saccular nerve foramina. CONCLUSION We think that revealing the anatomical, structural and numerical variations in the fundus will be useful in explaining the disease-symptom relationship. LEVEL OF EVIDENCE Level 4.
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Affiliation(s)
- Elif Sarı
- Istanbul Aydin University, Faculty of Medicine, Department of Otorhinolaryngology, Istanbul, Turkey.
| | - Gkionoul Nteli Chatzioglou
- Istanbul Health and Technology University, Faculty of Medicine, Department of Anatomy, Istanbul, Turkey; Istanbul University, Faculty of Medicine, Department of Anatomy, Istanbul, Turkey
| | - Dastan Temirbekov
- Istanbul Aydin University, Faculty of Medicine, Department of Otorhinolaryngology, Istanbul, Turkey
| | - Aynur Aliyeva
- The Cincinnati Children's Hospital Medical Center, The Division of the Otolaryngology, Ohio, USA
| | - Adnan Öztürk
- Istanbul Health and Technology University, Faculty of Medicine, Department of Anatomy, Istanbul, Turkey; Istanbul University, Faculty of Medicine, Department of Anatomy, Istanbul, Turkey
| | - Ilke Ali Gürses
- Koc University, Faculty of Medicine, Department of Anatomy, Istanbul, Turkey
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Tighilet B, Trico J, Marouane E, Zwergal A, Chabbert C. Histaminergic System and Vestibular Function in Normal and Pathological Conditions. Curr Neuropharmacol 2024; 22:1826-1845. [PMID: 38504566 DOI: 10.2174/1570159x22666240319123151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/20/2023] [Accepted: 10/13/2023] [Indexed: 03/21/2024] Open
Abstract
Most neurotransmitter systems are represented in the central and peripheral vestibular system and are thereby involved both in normal vestibular signal processing and the pathophysiology of vestibular disorders. However, there is a special relationship between the vestibular system and the histaminergic system. The purpose of this review is to document how the histaminergic system interferes with normal and pathological vestibular function. In particular, we will discuss neurobiological mechanisms such as neuroinflammation that involve histamine to modulate and allow restoration of balance function in the situation of a vestibular insult. These adaptive mechanisms represent targets of histaminergic pharmacological compounds capable of restoring vestibular function in pathological situations. The clinical use of drugs targeting the histaminergic system in various vestibular disorders is critically discussed.
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Affiliation(s)
- Brahim Tighilet
- Aix Marseille Université-CNRS, Laboratoire de Neurosciences Cognitives, LNC UMR 7291, Marseille, Groupe de Recherche Vertige (GDR#2074), France
| | - Jessica Trico
- Aix Marseille Université-CNRS, Laboratoire de Neurosciences Cognitives, LNC UMR 7291, Marseille, Groupe de Recherche Vertige (GDR#2074), France
| | - Emna Marouane
- Aix Marseille Université-CNRS, Laboratoire de Neurosciences Cognitives, LNC UMR 7291, Marseille, Groupe de Recherche Vertige (GDR#2074), France
- Normandie Université, UNICAEN, INSERM, COMETE, CYCERON, CHU Caen, 14000, Caen, France
| | - Andreas Zwergal
- Department of Neurology, LMU University Hospital, Munich, Germany
- German Center for Vertigo and Balance Disorders, LMU University Hospital, Munich, Germany
| | - Christian Chabbert
- Aix Marseille Université-CNRS, Laboratoire de Neurosciences Cognitives, LNC UMR 7291, Marseille, Groupe de Recherche Vertige (GDR#2074), France
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Strupp M, Churchill GC, Naumann I, Mansmann U, Al Tawil A, Golentsova A, Goldschagg N. Examination of betahistine bioavailability in combination with the monoamine oxidase B inhibitor, selegiline, in humans-a non-randomized, single-sequence, two-period titration, open label single-center phase 1 study (PK-BeST). Front Neurol 2023; 14:1271640. [PMID: 37920833 PMCID: PMC10619746 DOI: 10.3389/fneur.2023.1271640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 09/04/2023] [Indexed: 11/04/2023] Open
Abstract
Background Betahistine was registered in Europe in the 1970s and approved in more than 80 countries as a first-line treatment for Menière's disease. It has been administered to more than 150 million patients. However, according to a Cochrane systematic review of betahistine and recent meta-analyses, there is insufficient evidence to say whether betahistine has any effect in the currently approved dosages of up to 48 mg/d. A combination with the monoamine oxidase B (MAO-B) inhibitor, selegiline, may increase the bioavailability of betahistine to levels similar to the well-established combination of L-DOPA with carbidopa or benserazide in the treatment of Parkinson's disease. We investigated the effect of selegiline on betahistine pharmacokinetics and the safety of the combination in humans. Methods In an investigator-initiated prospective, non-randomized, single-sequence, two-period titration, open label single-center phase 1 study, 15 healthy volunteers received three single oral dosages of betahistine (24, 48, and 96 mg in this sequence with at least 2 days' washout period) without and with selegiline (5 mg/d with a loading period of 7 days). Betahistine serum concentrations were measured over a period of 240 min at eight time points (area under the curve, AUC0-240 min). This trial is registered with EudraCT (2019-002610-39) and ClinicalTrials.gov. Findings In all three single betahistine dosages, selegiline increased the betahistine bioavailability about 80- to 100-fold. For instance, the mean (±SD) of the area under curve for betahistine 48 mg alone was 0.64 (+/-0.47) h*ng/mL and for betahistine plus selegiline 53.28 (+/-37.49) h*ng/mL. The half-life time of around 30 min was largely unaffected, except for the 24 mg betahistine dosage. In total, 14 mild adverse events were documented. Interpretation This phase 1 trial shows that the MAO-B inhibitor selegiline increases betahistine bioavailability by a factor of about 80 to 100. No safety concerns were detected. Whether the increased bioavailability has an impact on the preventive treatment of Menière's disease, acute vestibular syndrome, or post-BPPV residual dizziness has to be evaluated in placebo-controlled trials. Clinical trial registration https://clinicaltrials.gov/study/NCT05938517?intr=betahistine%20and%20selegiline&rank=1, identifier: NCT05938517.
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Affiliation(s)
- Michael Strupp
- Department of Neurology and German Center for Vertigo and Balance Disorders, LMU University Hospital, LMU Munich, Munich, Germany
| | - Grant C. Churchill
- Department of Pharmacology, University of Oxford, Oxford, United Kingdom
| | - Ivonne Naumann
- Department of Neurology and German Center for Vertigo and Balance Disorders, LMU University Hospital, LMU Munich, Munich, Germany
| | - Ulrich Mansmann
- Department of Medical Information Sciences, Biometry and Epidemiology, Ludwig Maximilians University, Munich, Germany
| | - Amani Al Tawil
- Department of Medical Information Sciences, Biometry and Epidemiology, Ludwig Maximilians University, Munich, Germany
| | - Anastasia Golentsova
- Department of Neurology and German Center for Vertigo and Balance Disorders, LMU University Hospital, LMU Munich, Munich, Germany
| | - Nicolina Goldschagg
- Department of Neurology and German Center for Vertigo and Balance Disorders, LMU University Hospital, LMU Munich, Munich, Germany
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Kong L, Domarecka E, Szczepek AJ. Histamine and Its Receptors in the Mammalian Inner Ear: A Scoping Review. Brain Sci 2023; 13:1101. [PMID: 37509031 PMCID: PMC10376984 DOI: 10.3390/brainsci13071101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/14/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Histamine is a widely distributed biogenic amine with multiple biological functions mediated by specific receptors that determine the local effects of histamine. This review aims to summarize the published findings on the expression and functional roles of histamine receptors in the inner ear and to identify potential research hotspots and gaps. METHODS A search of the electronic databases PubMed, Web of Science, and OVID EMBASE was performed using the keywords histamine, cochlea*, and inner ear. Of the 181 studies identified, 18 eligible publications were included in the full-text analysis. RESULTS All four types of histamine receptors were identified in the mammalian inner ear. The functional studies of histamine in the inner ear were mainly in vitro. Clinical evidence suggests that histamine and its receptors may play a role in Ménière's disease, but the exact mechanism is not fully understood. The effects of histamine on hearing development remain unclear. CONCLUSIONS Existing studies have successfully determined the expression of all four histamine receptors in the mammalian inner ear. However, further functional studies are needed to explore the potential of histamine receptors as targets for the treatment of hearing and balance disorders.
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Affiliation(s)
- Lingyi Kong
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Ewa Domarecka
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Agnieszka J Szczepek
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, 10117 Berlin, Germany
- Faculty of Medicine and Health Sciences, University of Zielona Gora, 65-046 Zielona Gora, Poland
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Sutton L, Ghedia R, Harcourt J. Betahistine Prescribing Practices in England: An Analysis of Prescribing and National Spending Pre- and Post-BEMED Trial. Otol Neurotol 2023; 44:e406-e411. [PMID: 37254242 DOI: 10.1097/mao.0000000000003890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE Betahistine has not been proven to be superior to placebo in the BEMED study, a multicenter, double-blind, randomized, placebo controlled trial. Our study aimed to establish the prescribing practices of clinicians in England in relation to betahistine and to assess if there has been any change in prescribing practices since the publication of the BEMED trial. STUDY DESIGN Retrospective study and clinician survey. PATIENTS All patients who were prescribed betahistine from primary care. MAIN OUTCOME MEASURE Total quantity of betahistine prescribed and total actual cost. RESULTS The average total monthly quantity prescribed was 11,143,253 tablets (range, 10,056,516-12,276,423). Prescribing did not decrease from the period before (January 2014-February 2016) to after (February 2016-February 2021) the publication of the BEMED trial, with the average monthly prescribing before publication being 11,294,848 tablets (range, 10,280,942- 12,276,423) and the average monthly prescribing after publication being 11,081,123 tablets (range, 10,056,516-11,915,707). The average actual monthly cost increased from the period before publication to after publication from a sum of £279,264.82 to a sum of £428,846.22. Most (90.5%) of the survey respondents prescribed betahistine for Menière's disease. Less than half (38.09%) prescribed betahistine for indications other than Menière's disease. Only 45.24% of the clinicians were aware of the results of the BEMED trial. CONCLUSIONS Knowledge of the BEMED trial among otology and neurotology subspecialists is lacking. The results of the BEMED have made no difference to prescribing practice, and in fact, the cost of the medication to the health bill has increased.
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Affiliation(s)
- Liam Sutton
- Department of Otolaryngology, Charing Cross Hospital, Imperial College Healthcare NHS Trust
| | - Reshma Ghedia
- Department of Otolaryngology, The Royal National ENT Hospital, London, UK
| | - Jonny Harcourt
- Department of Otolaryngology, Charing Cross Hospital, Imperial College Healthcare NHS Trust
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Bifenestral surgical and chemical labyrinthectomy, a new effective ablative surgical approach to intractable vertigo in Ménière Disease elderly Patients. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2022; 74:169-174. [PMID: 36191896 DOI: 10.1016/j.otoeng.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
INTRODUCTION In this article, the bi-fenestral surgical chemical labyrinthectomy is introduced as a surgical demolition technique for treating resisting incurable forms of Meniere's disease in patients aged over 70 and/or with low hearing residues refractory to medical treatment. MATERIALS AND METHODS The results on participants fitting the inclusion criteria (n = 16) were reported using anamnesis (frequency of the crisis), Dizziness Handicap Inventory (DHI) and Functional Level Scale (FLS) before and after the intervention. RESULTS Vertigo control was achieved in all patients of this case series. A difference of 57 and 3.67 in mean DHI (from 68 (SD 16,7) to 11 (SD 14)) and FLS (from 4,68 (SD 0,7) to 0,1 (SD 0,3)) scores respectively were seen after an average of 16.28 months. Contextually tinnitus was reported to improve in seven patients (43,75%), aggravate in three (18,75%) and remain unchanged in the remaining six(37,5%). CONCLUSION Bi-fenestral surgical chemical labyrinthectomy appears a safe, immediate, and effective demolition treatment for vertigo control in a restricted class of patients affected by intractable Meniere disease.
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Kloos B, Bertlich M, Spiegel JL, Freytag S, Lauer SK, Canis M, Weiss BG, Ihler F. Low Dose Betahistine in Combination With Selegiline Increases Cochlear Blood Flow in Guinea Pigs. Ann Otol Rhinol Laryngol 2022; 132:519-526. [PMID: 35656811 PMCID: PMC10108341 DOI: 10.1177/00034894221098803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Betahistine is frequently used in the pharmacotherapy for Menière's Disease (MD). Little is known about its mode of action and prescribed dosages vary. While betahistine had an increasing effect on cochlear microcirculation in earlier studies, low dose betahistine of 0.01 mg/kg bw or less was not able to effect this. Selegiline inhibits monoaminooxidase B and therefore potentially the breakdown of betahistine. The goal of this study was to examine whether the addition of selegiline to low dose betahistine leads to increased cochlear blood flow. METHODS Twelve Dunkin-Hartley guinea pigs were anesthetized, the cochlea was exposed and a window opened to the stria vascularis. Blood plasma was visualized by injecting fluoresceinisothiocyanate-dextrane and vessel diameter and erythrocyte velocity were evaluated over 20 minutes. One group received low dose betahistine (0.01 mg/kg bw) and selegiline (1 mg/kg bw) i.v. while the other group received only selegiline (1 mg/kg bw) and saline (0.9% NaCl) as placebo i.v. RESULTS Cochlear microcirculation increased significantly (P < .001) in guinea pigs treated with low dose betahistine combined with selegiline by up to 58.3 ± 38.7% above baseline over a period of up to 11 minutes. In one guinea pig, the increase was 104.6%. Treatment with Selegiline alone did not affect microcirculation significantly. CONCLUSIONS Low dose betahistine increased cochlear microcirculation significantly when combined with selegiline. This should be investigated in further studies regarding dose-effect relation in comparison to betahistine alone. Side effects, in particular regarding circulation, should be considered carefully in view of the clinical applicability of a combination therapy in patients with MD.
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Affiliation(s)
- Benedikt Kloos
- Department of Otorhinolaryngology, University Hospital, LMU Munich, Munich, Germany.,Institute of Surgical Research, Walter-Brendel-Centre of Experimental Medicine, University Hospital, LMU Munich, Munich, Germany.,German Center for Vertigo and Dizziness (DSGZ), LMU Munich, Munich, Germany
| | - Mattis Bertlich
- Department of Otorhinolaryngology, University Hospital, LMU Munich, Munich, Germany.,Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
| | - Jennifer L Spiegel
- Department of Otorhinolaryngology, University Hospital, LMU Munich, Munich, Germany
| | - Saskia Freytag
- Molecular Medicine, Harry Perkins Institute of Medical Research, Perth, WA, Australia
| | - Susanne K Lauer
- Clinic for Small Animal Surgery and Reproduction, LMU Munich, Munich, Germany
| | - Martin Canis
- Department of Otorhinolaryngology, University Hospital, LMU Munich, Munich, Germany
| | - Bernhard G Weiss
- Department of Otorhinolaryngology, University Hospital, LMU Munich, Munich, Germany
| | - Friedrich Ihler
- Department of Otorhinolaryngology, University Hospital, LMU Munich, Munich, Germany.,Institute of Surgical Research, Walter-Brendel-Centre of Experimental Medicine, University Hospital, LMU Munich, Munich, Germany.,German Center for Vertigo and Dizziness (DSGZ), LMU Munich, Munich, Germany.,Department of Ear, Nose and Throat Diseases, Head and Neck Surgery, Greifswald, Germany
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Neurotransmitter and Neurotransmitter Receptor Expression in the Saccule of the Human Vestibular System. Prog Neurobiol 2022; 212:102238. [DOI: 10.1016/j.pneurobio.2022.102238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 01/19/2022] [Accepted: 01/28/2022] [Indexed: 11/18/2022]
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Weiss BG, Freytag S, Kloos B, Haubner F, Sharaf K, Spiegel JL, Canis M, Ihler F, Bertlich M. Cannabinoid Receptor 2 Agonism is Capable of Preventing Lipopolysaccharide Induced Decreases of Cochlear Microcirculation - A Potential Approach for Inner Ear Pathologies. Otol Neurotol 2021; 42:e1396-e1401. [PMID: 34267099 DOI: 10.1097/mao.0000000000003280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
HYPOTHESIS The ability of JWH-133, an agonist at the cannabinoid receptor 2, to abrogate the effects of lipopolysaccharide on cochlear microcirculation was investigated. BACKGROUND Cochlear inflammation and subsequent impairment of microcirculation is part of numerous pathologies affecting inner ear function, including suppurative labyrinthitis, noise trauma, and sudden sensorineural hearing loss. One way of causing cochlear inflammation is exposing the cochlea to lipopolysaccharide, a bacterial endotoxin. METHODS Twenty Dunkin-hartley guinea pigs were divided into four groups of five animals each. Two groups received topic treatment with JWH-133 and two received treatment with placebo. One group that had been treated with JWH-133 and one with placebo were then exposed to lipopolysaccharide or placebo, respectively. Cochlear microcirculation was quantified before, in between and after treatments by in vivo fluorescence microscopy. RESULTS Significantly different changes in cochlear blood flow were only seen in the group that was treated with placebo and subsequently lipopolysaccharide. Every other group showed no significant change in cochlear blood flow. CONCLUSION JWH-133 is capable of abrogating the effects of lipopolysaccharide on cochlear microcirculation. It may therefore be clinical interest in treating numerous inflammation associated cochlear pathologies.
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Affiliation(s)
- Bernhard G Weiss
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig-Maximilians-University of Munich, Marchioninistr. 15
- Walter Brendel Centre of Experimental Medicine, University of Munich Hospital, Marchioninistr. 27, 81377 Munich, Germany
| | - Saskia Freytag
- Population Health and Immunity Division, Walter and Eliza Hall Institute, 1G Royal Parade
- Department of Medical Biology, University of Melbourne, 3052, Parkville, Australia
| | - Benedikt Kloos
- Walter Brendel Centre of Experimental Medicine, University of Munich Hospital, Marchioninistr. 27, 81377 Munich, Germany
| | - Frank Haubner
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig-Maximilians-University of Munich, Marchioninistr. 15
| | - Kariem Sharaf
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig-Maximilians-University of Munich, Marchioninistr. 15
- Walter Brendel Centre of Experimental Medicine, University of Munich Hospital, Marchioninistr. 27, 81377 Munich, Germany
| | - Jennifer Lee Spiegel
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig-Maximilians-University of Munich, Marchioninistr. 15
| | - Martin Canis
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig-Maximilians-University of Munich, Marchioninistr. 15
- Walter Brendel Centre of Experimental Medicine, University of Munich Hospital, Marchioninistr. 27, 81377 Munich, Germany
| | - Friedrich Ihler
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig-Maximilians-University of Munich, Marchioninistr. 15
- Walter Brendel Centre of Experimental Medicine, University of Munich Hospital, Marchioninistr. 27, 81377 Munich, Germany
| | - Mattis Bertlich
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig-Maximilians-University of Munich, Marchioninistr. 15
- Walter Brendel Centre of Experimental Medicine, University of Munich Hospital, Marchioninistr. 27, 81377 Munich, Germany
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Zhang S, Gong Y, Liang Y, Wang B, Gao W, Xu Q. Cyclophosphamide inhibits the progression of Meniere's disease by reducing the generation of circulating immune complex. Exp Ther Med 2021; 22:1177. [PMID: 34504622 PMCID: PMC8393373 DOI: 10.3892/etm.2021.10611] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 11/26/2020] [Indexed: 11/19/2022] Open
Abstract
Endolymphatic hydrops is a characteristic pathological manifestation of Meniere's disease (MD) that has been previously associated with autoimmunity. Interest in the circulating immune complex (CIC) has increased due to its reported role in the occurrence of MD. The present study aimed to investigate the potential value of serum CIC concentration in the diagnosis of MD and the therapeutic potential of cyclophosphamide (CTX) for the treatment of MD. In the present study, guinea pigs were immunized with isologous crude inner ear antigens to establish an autoimmune MD model. Pure tone audiometry, Vestibular-evoked myogenic potential test, electrocochleography test and auditory brainstem response was applied in this study for assessing the severity of MD in guinea pigs. ELISA was applied to measure CIC, tumor necrosis factor α (TNF-α) and heat shock protein 70 (HSP70) expression levels in the serum samples of different groups of patients. Western blotting was applied to detect the protein expression of HSP70 in inner ear tissues in guinea pigs. Hematoxylin and eosin staining was applied to visualize the spiral ganglions in spiral ganglions models. CIC expression in the inner ear was detected by immunohistochemistry. In vivo experiments were performed to confirm the therapeutic effects of CTX in MD. Serum concentrations of CIC, TNF-α and HSP70 were found to be significantly higher in patients with MD, which were also associated with increases in hearing classification and the severity of endolymphatic hydrops. Using a guinea pig MD model, ELISA results revealed significantly increased serum CIC, TNF-α and HSP70 concentrations compared with those in the control group. ABR results showed that the thresholds in the CTX group were notably decreased compared with that in the dexamethasone group, whereas CIC concentrations in the serum were reduced following dexamethasone and CTX treatments compared with those after saline treatment. In the inner ear tissues, the CIC concentration in CTX group was lower than that in the dexamethasone group. Similarly, reductions in HSP70 and TNF-α concentrations was also observed in a similar manner. Immunohistochemistry staining found notably lower CIC deposition in the inner ear tissues following CTX treatment than that in dexamethasone group. Taken together, higher CIC expression can be used as a biomarker for MD diagnosis. The efficacy of CTX in MD was found to be higher compared with that in dexamethasone, which may be associated with the effective inhibition of CIC, HSP70 and TNF-α generation.
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Affiliation(s)
- Shu Zhang
- Department of Otolaryngology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia 010110, P.R. China
| | - Yulin Gong
- Department of Rheumatology and Immunology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia 010110, P.R. China
| | - Yu Liang
- Department of Computer Information and Network Management Center, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia 010110, P.R. China
| | - Boqian Wang
- Department of Otolaryngology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia 010110, P.R. China
| | - Wei Gao
- Department of Otolaryngology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia 010110, P.R. China
| | - Qianyun Xu
- Department of Otolaryngology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia 010110, P.R. China
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Abstract
The number of older people has been increasing over recent decades in Western populations. Dizziness, imbalance, and vertigo constitute some of the most common complaints in older patients, and risk of falling is the most frequent and worrying consequence. It has been reported that 15–20% of the adult population experiences these debilitating symptoms. Among the diseases that may be associated with vertigo, the three classes of otological, central, and functional (psychological) dizziness may be distinguished. Overall, vestibular disorders account for 48% of vertiginous complaints in the older population. The main focus of this article is to review the forms of pharmacotherapy for vertigo, especially with regard to older patients, who may be treated simultaneously with other drugs for different comorbidities. Interactions with other drugs should be considered in the choice of a particular course of treatment. Moreover, overuse of pharmacotherapy for the management of vertigo in the elderly may prevent the development of the central compensatory mechanism that sustains both static and dynamic imbalance after a vertiginous crisis. In the majority of patients, vestibular and physical rehabilitation are strongly advised and rarely contraindicated.
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Molnár A, Maihoub S, Tamás L, Szirmai Á. Effectiveness of intratympanic dexamethasone for the treatment of vertigo attacks in patients with Ménière's disease compared with betahistine pharmacotherapy. J Int Med Res 2021; 49:300060520985647. [PMID: 33845616 PMCID: PMC8047842 DOI: 10.1177/0300060520985647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE This study analyzed the possible effects of intratympanic steroid (ITS) therapy in the symptomatic treatment of vertigo attacks in patients with Ménière's disease. METHODS Thirty-five patients treated with ITS (dexamethasone) plus betahistine (Group A) and 35 patients treated with betahistine alone (Group B) were enrolled in this investigation. Complaints were analyzed using medical records and vertigo diaries. Statistical analysis was conducted using IBM SPSS V24 software. RESULTS Based on the analysis, there were no significant differences in baseline features between the two groups. When the occurrence of vertigo attacks was compared using the Kaplan-Meier method, no significant difference was detected between Groups A and B (odds ratio [OR] = 1.051, 95% confidence interval [CI] = 0.965-1.067; p = 0.972). In addition, no difference in the incidence of vertigo attacks was noted in group A between the periods of treatment with betahistine alone and betahistine plus ITS when the groups were analyzed via logistic regression (OR = 1.07, 95% CI = 0.065-1.467; p = 0.614). CONCLUSION It can be concluded that the addition of ITS therapy to betahistine did not improve outcomes in patients with Ménière's disease. Further prospective studies should be conducted to analyze the results in a more detailed manner.
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Affiliation(s)
- András Molnár
- 37637Semmelweis University, Department of Otolaryngology and Head and Neck Surgery, Budapest, Hungary
| | - Stefani Maihoub
- 37637Semmelweis University, Department of Otolaryngology and Head and Neck Surgery, Budapest, Hungary
| | - László Tamás
- 37637Semmelweis University, Department of Otolaryngology and Head and Neck Surgery, Budapest, Hungary
| | - Ágnes Szirmai
- 37637Semmelweis University, Department of Otolaryngology and Head and Neck Surgery, Budapest, Hungary
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15
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Zamergrad MV, Kunelskaya NL, Guseva AL, Amelin AV, Lilenko SV, Samartcev IN, Zaytseva OV, Melnikov OA, Voronov VA, Lyapin AV. [Betahistine in vestibular disorders: current concepts and perspectives]. Vestn Otorinolaringol 2021; 86:73-81. [PMID: 33929156 DOI: 10.17116/otorino20218602173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The goal of this paper is to review the pharmacological profile of betahistine and evidence for using it in the treatment of common vestibular disorders. Betahistine is a weak agonist for histamine H1 receptors and strong antagonist for histamine H3 receptors. It demonstrates the maximum benefit in different types of peripheral vertigo, especially in Meniere's disease. The best results in decreasing intensity of vertigo, frequency of attacks and stimulation of vestibular compensation were obtained in daily dose 48 mg during 3 months. In benign paroxysmal positional vertigo betahistine is used to treat residual dizziness after successful treatment of otolithiasis and to reduce the severity of vertigo during repositioning maneuvers. In vestibular neuritis betahistine stimulates central compensation during vestibular rehabilitation. A new once-daily drug formulation of modified-release betahistine is non-inferior to traditional and has a comparable safety profile, and could improve patient adherence. The implication of betahistine in the treatment of central vestibular disorders is under-researched. The efficacy of betahistine in increasing of vestibular compensation in post-stroke central vestibular disorders, persistent postural-perceptual dizziness and its role in vestibular migraine need further investigation.
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Affiliation(s)
- M V Zamergrad
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia.,Russian Gerontology Clinical Research Center of Pirogov Russian National Research Medical University
| | - N L Kunelskaya
- Russian Gerontology Clinical Research Center of Pirogov Russian National Research Medical University.,Sverzhevsky Research Institute of Clinical Otorhinolaryngology, Moscow, Russia
| | - A L Guseva
- Russian Gerontology Clinical Research Center of Pirogov Russian National Research Medical University
| | - A V Amelin
- Pavlov First St. Petersburg State Medical University, St. Petersburg, Russia
| | - S V Lilenko
- Saint Petersburg ENT and Speech Research Institute, St. Petersburg, Russia.,North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, Russia
| | - I N Samartcev
- Kirov Military Medical Academy, St. Petersburg, Russia
| | - O V Zaytseva
- Scientific and Clinical Center of Otorhinolaryngology of the Federal Medico-Biological Agency of the Russian Federation, Mosco, Scientific and Clinical Center of Otorhinolaryngology of the Federal Medico-Biological Agency of the Russian Federation, Moscow
| | - O A Melnikov
- Center of vertigo and balance disorders, GUTA CLINIC, Moscow, Russia
| | - V A Voronov
- North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, Russia
| | - A V Lyapin
- Federal Siberian Research Clinical Centre under the Federal Medical Biological Agency, Krasnoyarsk, Russia
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16
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Kepekçi AH, Gündoğan Gİ, Kıg C. In Vitro Physiological Effects of Betahistine on Cell Lines of Various Origins. Turk J Pharm Sci 2021; 18:140-145. [PMID: 33900698 DOI: 10.4274/tjps.galenos.2020.88155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Objectives Betahistine is a histamine analog commonly prescribed for symptomatic treatment of vertiginous symptoms. In vitro studies have shown that betahistine was not toxic at the prescribed doses in a nasal epithelial cell line. However, the effect of betahistine on other cell types has not been studied. In this study, we aimed to investigate some of the physiological effects of betahistine on L929 fibroblast, A549 lung cancer, human umbilical vein endothelial (HUVEC), and Ishikawa endometrial cell lines. Materials and Methods Cellular proliferation was assed assessed by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay, apoptosis was evaluated by acridine orange-ethidium bromide staining, and cellular migration was assed assessed by scratch assay. Results Betahistine treatment (0.1-0.5 mg/mL, 24 hours) can inhibit cell proliferation and induce apoptosis in HUVEC, A549, Ishikawa, and L929 cell lines. Betahistine (≥0.1 mg/mL) significantly increased the number of apoptotic cells (HUVEC: 26.3%, A549: 17.3%, L929: 8.6%, and Ishikawa: 2.3%). Betahistine at doses over 0.1 mg/mL significantly suppressed the cell migration rate in all of the cell lines. In contrast, exposure to a low dose of betahistine (0.025 mg/mL) induced migration rates of HUVEC and Ishikawa cells by 81% and 48%, respectively. Conclusion Betahistine may alter the processes of cellular proliferation, apoptosis, and cellular migration in a cell line- and dose-dependent manner. In this sense, proliferative and metastatic properties of certain cancer cells can potentially be altered in response to betahistine treatment.
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Affiliation(s)
- Ahmet Hamdi Kepekçi
- Istanbul Yeni Yuzyil University Health Vocational School, Divison of Audiometry, Istanbul, Turkey
| | - Gül İpek Gündoğan
- Istanbul Yeni Yuzyil University Faculty of Medicine, Department of Histology and Embryology, Istanbul, Turkey
| | - Cenk Kıg
- Istanbul Yeni Yuzyil University Faculty of Medicine, Department of Medical Biology and Genetics, Istanbul, Turkey
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17
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Zwergal A, Dieterich M. [Update on diagnosis and therapy in frequent vestibular and balance disorders]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2021; 89:211-220. [PMID: 33873210 DOI: 10.1055/a-1432-1849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The 8 most frequent vestibular disorders account for more than 70% of all presentations of vertigo, dizziness, and imbalance. In acute (and mostly non-repetitive) vestibular disorders acute unilateral vestibulopathy and vestibular stroke are most important, in episodic vestibulopathies benign paroxysmal positional vertigo (BPPV), Menière's disease and vestibular migraine, and in chronic vestibular disorders bilateral vestibulopathy/presbyvestibulopathy, functional dizziness and cerebellar dizziness. In the last decade, internationally consented diagnostic criteria and nomenclature were established for the most frequent vestibular disorders, which can be easily applied in clinical practice. The diagnostic guidelines are based on history taking (including onset, duration, course, triggers, accomanying symptoms), clinical examination, and only a few apparative tests (by videooculography and audiometry) for securing the diagnosis. Treatment of vestibular disorders includes physical training (repositioning maneuvers, multimodal balance training) and pharmacological approaches (e.g., corticosteroids, antiepileptics, antidepressants, potassium-canal-blockers, drugs enhancing neuroplasticity). For most drugs, high-level evidence from prospective controlled trials is lacking. In clinical practice, the most frequent vestibular disorders can be treated effectively, thus avoiding chronicity and secondary comorbidity (by immobility, falls or psychiatric disorders such as anxiety or depression).
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Affiliation(s)
- Andreas Zwergal
- LMU Klinikum, Neurologische Klinik und Deutsches Schwindel- und Gleichgewichtszentrum (DSGZ)
| | - Marianne Dieterich
- LMU Klinikum, Neurologische Klinik und Deutsches Schwindel- und Gleichgewichtszentrum (DSGZ)
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18
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Bertlich M, Ihler F, Spiegel JL, Canis M, Weiss BG. Intratympanal administration of lidocaine in the management of Ménière's Disease. Acta Otolaryngol 2021; 141:209-215. [PMID: 33190578 DOI: 10.1080/00016489.2020.1844289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Ménière's Disease (MD) is a chronic condition where patients suffer recurrent vertigo attacks. Evidence for treatment concepts are to this date low. AIMS/OBJECTIVE To evaluate the therapeutic effect of intratympanic lidocaine injections to reduce the number of attacks. METHODS Twenty patients diagnosed with definitive MD that were treated with 34 intratympanic lidocaine injections were included. Main outcome measures were the number of vertigo attacks in the previous four weeks, the attack free period and the subjective improvement of the condition. RESULTS Mean follow up after first lidocaine injection was 25.3 months (±22.2; range 1.9-79.7). Patients expressed subjective improvement in overall situation, vertigo, and aural fullness. The number of vertigo attacks before each assessment decreased from 7.1 (±5.9; range 2-20) per months at baseline to 1.9 (±3.8; range 0-15). 25% of the patients suffered no further attacks, the other patients had an average attack free period of 7.8 months (±15.4; range 0.2-58.4). Hearing thresholds remained unaffected. Repetitive injections proved effective. CONCLUSION AND SIGNIFICANCE Intratympanic lidocaine is an effective nonsurgical and non-ablative therapy for MD. When patients experience an increase of attacks repetitive injections promise improvement.
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Affiliation(s)
- Mattis Bertlich
- Department of Otorhinolaryngology, Ludwig-Maximilians University of Munich, Munich, Germany
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Göttingen, Göttingen, Germany
| | - Friedrich Ihler
- Department of Otorhinolaryngology, Ludwig-Maximilians University of Munich, Munich, Germany
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Göttingen, Göttingen, Germany
- German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians University Munich, Munich, Germany
| | - Jennifer Lee Spiegel
- Department of Otorhinolaryngology, Ludwig-Maximilians University of Munich, Munich, Germany
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Göttingen, Göttingen, Germany
| | - Martin Canis
- Department of Otorhinolaryngology, Ludwig-Maximilians University of Munich, Munich, Germany
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Göttingen, Göttingen, Germany
| | - Bernhard G. Weiss
- Department of Otorhinolaryngology, Ludwig-Maximilians University of Munich, Munich, Germany
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Göttingen, Göttingen, Germany
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19
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Zabaneh SI, Voss LJ, Szczepek AJ, Olze H, Stölzel K. Methods for Testing the Subjective Visual Vertical during the Chronic Phase of Menière's Disease. Diagnostics (Basel) 2021; 11:diagnostics11020249. [PMID: 33562708 PMCID: PMC7915072 DOI: 10.3390/diagnostics11020249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 12/25/2022] Open
Abstract
The subjective visual vertical (SVV) evaluates the function of the utricle, which, in patients with Menière’s disease (MD), can be affected by endolymphatic hydrops. This study aimed to determine the SVV in MD patients during the chronic phase of illness compared to healthy participants. The second aim was to compare the SVV measurement tools: the analog bucket test, digital bucket test, and C-SVV© goggles. The SVV scores differed significantly between MD patients and the control group for the analog bucket test (p < 0.001) and the C-SVV® goggles (p = 0.028), but no significance was shown when using the digital bucket test (p = 0.062). When comparing the analog bucket test and the C-SVV® goggles applying the calculated threshold (1.125° in analog bucket test, 2.5° in C-SVV® goggles), the bucket test showed higher accuracy (bucket test 73.84%, C-SVV® goggles 69.23%). When examining the influence of betahistine on SVV scores, there were no statistically significant differences in both the analog bucket test and C-SVV© goggles. We conclude that SVV test can be used as an additional tool to evaluate utricle function during the chronic phase of MD and that the analog bucket test produces the most reliable results. The intake of betahistine does not influence the perception of SVV.
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Affiliation(s)
- Samira Ira Zabaneh
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität, Berlin Humboldt Universität zu Berlin and Berlin Institute of Health, Campus Charité Mitte, Chariteplatz 1, 10117 Berlin, Germany; (S.I.Z.); (A.J.S.); (H.O.)
| | - Linda Josephine Voss
- Department of Audiology and Phoniatrics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität, Berlin Humboldt Universität zu Berlin and Berlin Institute of Health, Campus Charité Mitte, Chariteplatz 1, 10117 Berlin, Germany;
| | - Agnieszka J. Szczepek
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität, Berlin Humboldt Universität zu Berlin and Berlin Institute of Health, Campus Charité Mitte, Chariteplatz 1, 10117 Berlin, Germany; (S.I.Z.); (A.J.S.); (H.O.)
| | - Heidi Olze
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität, Berlin Humboldt Universität zu Berlin and Berlin Institute of Health, Campus Charité Mitte, Chariteplatz 1, 10117 Berlin, Germany; (S.I.Z.); (A.J.S.); (H.O.)
| | - Katharina Stölzel
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität, Berlin Humboldt Universität zu Berlin and Berlin Institute of Health, Campus Charité Mitte, Chariteplatz 1, 10117 Berlin, Germany; (S.I.Z.); (A.J.S.); (H.O.)
- Correspondence:
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20
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Espinosa-Sanchez JM, Lopez-Escamez JA. The pharmacological management of vertigo in Meniere disease. Expert Opin Pharmacother 2020; 21:1753-1763. [DOI: 10.1080/14656566.2020.1775812] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Juan Manuel Espinosa-Sanchez
- Department of Otolaryngology, Instituto de Investigación Biosanitaria Ibs.GRANADA, Hospital Universitario Virgen de las Nieves, Universidad de Granada, Granada, Spain
- Otology & Neurotology Group CTS 495, Department of Genomic Medicine, GENYO. Centre for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional, Government PTS Granada, Granada, Spain
| | - José A. Lopez-Escamez
- Department of Otolaryngology, Instituto de Investigación Biosanitaria Ibs.GRANADA, Hospital Universitario Virgen de las Nieves, Universidad de Granada, Granada, Spain
- Otology & Neurotology Group CTS 495, Department of Genomic Medicine, GENYO. Centre for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional, Government PTS Granada, Granada, Spain
- Department of Surgery, Division of Otolaryngology, Universidad de Granada, Granada, Spain
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21
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Yazdi A, Doostmohammadi M, Pourhossein Majarshin F, Beheshti S. Betahistine, prevents kindling, ameliorates the behavioral comorbidities and neurodegeneration induced by pentylenetetrazole. Epilepsy Behav 2020; 105:106956. [PMID: 32062106 DOI: 10.1016/j.yebeh.2020.106956] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 01/26/2020] [Accepted: 01/29/2020] [Indexed: 12/20/2022]
Abstract
A seizure may occur because of the imbalance between glutamate and gamma-aminobutyric acid (GABA). Recurrent seizures induce some cognitive problems, such as, depression, learning and memory deficits, and neurodegeneration. Histamine is an appropriate therapeutic target for epilepsy via its effect on regulating neurotransmitter release. Also, evidence indicates the effect of histamine on neuroprotection and alleviating cognitive disorders. An ideal antiepileptic drug is a substance, which has both anticonvulsant effects and decreases the comorbidities that are induced by repeated seizures. Betahistine dihydrochloride (betahistine) is a structural analog of histamine. It acts as histamine H1 receptor agonist and H3 receptor antagonist, which enhances histaminergic neuronal activities. In the present study, we examined the effect of betahistine administration on seizure scores, memory deficits, depression, and neuronal loss induced by pentylenetetrazole (PTZ). Eight- to ten-week-old BALB/c male mice (20-25 g) received betahistine, 1, and 10 mg/kg daily from 7 days before the onset of PTZ-induced kindling until the end of the establishment of the kindling. We found that betahistine prevented generalized tonic-clonic seizures induction and diminished forelimb clonic seizures intensity. Also, it decreased cell death in the hippocampus and cortex, ameliorated the memory deficit and depression induced by PTZ in the kindled animals. Altogether, these results indicate that pretreatment and repetitive administration with betahistine exerts antiepileptogenic and anticonvulsant activity. These findings might be due to the neuroprotective impact of betahistine in the hippocampus and cortex.
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Affiliation(s)
- Azadeh Yazdi
- Department of Physiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Mohammadmahdi Doostmohammadi
- Department of Plant and Animal Biology, Faculty of Biological Science and Technology, University of Isfahan, Isfahan, Iran
| | - Farshid Pourhossein Majarshin
- Department of Plant and Animal Biology, Faculty of Biological Science and Technology, University of Isfahan, Isfahan, Iran
| | - Siamak Beheshti
- Department of Plant and Animal Biology, Faculty of Biological Science and Technology, University of Isfahan, Isfahan, Iran
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22
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Molnár A, Maihoub S, Tamás L, Szirmai Á. Conservative Treatment Possibilities of Ménière Disease, Involving Vertigo Diaries. EAR, NOSE & THROAT JOURNAL 2019; 100:536-542. [PMID: 31617407 DOI: 10.1177/0145561319881838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Ménière disease is a disorder of the inner ear, characterized by rotational vertigo, hearing loss, tinnitus, and vegetative symptoms. The aim of the present research is to examine the effectiveness of betahistine and piracetam in the reduction of vertigo attacks in Ménière disease. To verify our hypothesis, 105 (31 male and 74 females, mean age [standard deviation], 57.4 [11.05]) adult patients with definite Ménière disease were enrolled in this investigation. Beside the analysis of the hospital records, the subjective complaints of the patients and the completed vertigo diaries were taken into consideration too. The statistical analysis was completed using the IBM SPSS version 24 software. Retrospective analysis, including a 12 years period was conducted. Based on our results, betahistine was successful in the reduction of attacks. Statistically significant decrease was achieved in frequency of dizziness (P = .000331) and vertigo (P < .00001) and in the duration of them (P = .000098), although in the mean power of them was not (P = .0887). The mean dose in the symptomatic treatment was determined as 87.5 ± 27.2 mg per day; however, there was no connection detected between the dose of the agent and the effectiveness of the symptomatic control. By using dual therapy (betahistine and piracetam), vertigo episodes appeared significantly less often (P = .027, Odds ratio: 4.9, 95% confidence interval: 1.2-20.2). Finally, it can be concluded that betahistine is effective in Ménière disease, but the daily dose of it should be set up for every patient individually. The advantage of the dual therapy was also confirmed.
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Affiliation(s)
- András Molnár
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, 37637Semmelweis University, Budapest, Hungary
| | - Stephanie Maihoub
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, 37637Semmelweis University, Budapest, Hungary
| | - László Tamás
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, 37637Semmelweis University, Budapest, Hungary
| | - Ágnes Szirmai
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, 37637Semmelweis University, Budapest, Hungary
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23
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Magnan J, Özgirgin ON, Trabalzini F, Lacour M, Escamez AL, Magnusson M, Güneri EA, Guyot JP, Nuti D, Mandalà M. European Position Statement on Diagnosis, and Treatment of Meniere's Disease. J Int Adv Otol 2019; 14:317-321. [PMID: 30256205 DOI: 10.5152/iao.2018.140818] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Meniere Disease keeps challenges in its diagnosis and treatment since was defined by Prosper Meniere at the beginning of 19th Century. Several classifications and definition were made until now and speculations still exist on its etiology. As the etiology remains speculative the treatment models remain in discussion also. The European Academy of Otology and Neurotology Vertigo Guidelines Study Group intended to work on the diagnosis and treatment of Meniere's disease and created the European Positional Statement Document also by resuming the consensus studies on it. The new techniques on diagnosis are emphasized as well as the treatment models for each stage of the disease are clarified by disregarding the dilemmas on its treatment. The conservative, noninvasive and invasive therapeutic models are highlighted.
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Affiliation(s)
- Jacques Magnan
- Past Head of ORL and Head and Neck Surgery Hopital Nord, Aix Marseille University, Marseille, France
| | - O Nuri Özgirgin
- Department of Otolaryngology, Bayındır Hospital, Ankara, Turkey
| | - Franco Trabalzini
- Department of Otolaryngology, Ospedale Pediatrico Meyer, Firenze, Italy
| | - Michel Lacour
- Aix-Marseille Université, Fédération de recherche 3C: Cerveau, Comportement, Cognition de Marseille St Charles, Marseille, France
| | | | | | - Enis Alpin Güneri
- Department of Otolaryngology, Dokuz Eylul University School of Medicine, İzmir, Turkey
| | - Jean Philippe Guyot
- Department of Neurosciences, Hopitaux Universitaires Geneve, Geneve, Switzerland
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Kutlubaev MA, Pal'chun VT, Savel'eva EE, Guseva AL. [Vascular mechanisms in Meniere's disease]. Vestn Otorinolaringol 2019; 84:70-77. [PMID: 31198220 DOI: 10.17116/otorino20198402170] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Meniere's disease (MD) is chronic multifactorial medical condition caused by endolymphatic hydrops, which etiology is unclear. This review highlights possible vascular mechanisms of MD. Impairment of vascular regulation, further ischemic damage of labyrinth and venous drainage pathology could lead to endolymphatic hydrops. Epidemiologic studies reveal high comorbidity of MD and migraine. Both diseases could be the result of trigeminovascular dysfunction. Betahistine, the medication with vascular effect, is widely used in treatment of MD, the effectiveness of calcium channel blockers is evaluated. Keywords: vertigo, Meniere's disease, endolymphatichydrops, migraine, vascular mechanisms, betahistine.
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Affiliation(s)
- M A Kutlubaev
- Kuvatov Republican Clinical Hospital, Ufa, Russia, 450005,Bashkir State Medical University of the Ministry of Health of Russia, Ufa, Russia, 450000
| | - V T Pal'chun
- N.I. Pirogov Russian National Research Medical University of the Ministry of Health of Russia, Moscow, Russia, 117997,Sverzhevsky Research Institute of Clinical Otorhinolaryngology, Moscow, Russia, 117152
| | - E E Savel'eva
- Bashkir State Medical University of the Ministry of Health of Russia, Ufa, Russia, 450000
| | - A L Guseva
- N.I. Pirogov Russian National Research Medical University of the Ministry of Health of Russia, Moscow, Russia, 117997
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Casani AP, Guidetti G, Schoenhuber R. Report from a Consensus Conference on the treatment of Ménière's disease with betahistine: rationale, methodology and results. ACTA ACUST UNITED AC 2019; 38:460-467. [PMID: 30498275 PMCID: PMC6265668 DOI: 10.14639/0392-100x-2035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 02/18/2018] [Indexed: 01/18/2023]
Abstract
Ménière’s disease is a disorder of the inner ear that causes vertigo, tinnitus, fullness and hearing loss. Although several treatments are available, the success rate is reported to be around 70%, similar to placebo. Betahistine, a weak H1 receptor agonist and an effective H3 receptor antagonist, is frequently prescribed for Ménière’s disease, especially to reduce recurrent vertigo attacks. The effects of this drug on hearing and other audiological symptoms remains unclear. Given the inconclusive reports in the literature, we proposed a consensus conference on the use of betahistine in Ménière’s disease. The aim was to define best practice criteria for therapy for Ménière’s disease, improve clinical suitability and reduce heterogeneity of the therapeutic approach. The consensus conference on betahistine for Ménière’s disease involved a group of Italian experts in vestibular disorders who were asked a series of questions prepared by opinion leaders. The Delphi method, an iterative investigation method, was used to increase consensus. Via a tele-voting system, each participant anonymously evaluated all statements using a Likert 5-point scale. Betahistine was considered useful for the treatment of dizziness and vertigo during the intercritical phase of the disease (87% agreeing answers). However, during the acute phase of the disease betahistine was considered less effective and useful only when associated with other drugs (71% agreement). Similarly, the efficacy of the drug was considered low when used to reduce progressive hearing loss, tinnitus, and ear fullness. The experts advocated the use of betahistine during the intercritical phase of Ménière’s disease to reduce the number and severity of vertigo attacks. Its use seems to be at low risk of major side effects.
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Affiliation(s)
- A P Casani
- Department of Surgery and Medicine, Pisa University Hospital, Italy
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Canis M, Bertlich M. Cochlear Capillary Pericytes. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1122:115-123. [PMID: 30937866 DOI: 10.1007/978-3-030-11093-2_7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Capillary pericytes in the cochlea of mammals are-compared to pericytes in other tissues, like the CNS-relatively poorly researched. To begin with, there is still a considerable debate as to whether the very last precapillary arterioles should-due to their contractile properties-may be considered to be pericytes.However, cochlear capillary pericytes have shifted into the center of attention in the past decade. Most mammals show a considerable number of pericytes in the stria vascularis of the cochlea-up to 1300 in a mouse alone. This high number may be explained by the observation that cochlear capillary pericytes may be differentiated into different subgroups, depending on the immune markers that are expressed by them. Corresponding with these subpopulations, cochlear pericytes fulfill three core functions in the physiology of the cochlea: Formation of the intrastrial blood-fluid barrier-Pericytes monitor the ion, fluid, and nutrient household and aid in the homeostasis thereof. Regulation of cochlear blood flow-By contraction on relaxation, pericytes contribute to the regulation of cochlear blood flow, a paramount function parameter of the cochlea. Immune response-Pericytes actually contribute to the immune response in inflammation of the cochlea. Due to these central roles in the physiology of the cochlea, pericytes actually play a major role in numerous cochlear pathologies, including, but not limited to, sudden sensorineural hearing loss, acoustic trauma, and inflammation of the cochlea.
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Affiliation(s)
- Martin Canis
- The Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, Munich, Germany
| | - Mattis Bertlich
- The Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, Munich, Germany.
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Zyryanov SK, Butranova OI, Ramenskaya GV, Gildeeva GN, Shohin IE. [In vitro equivalence evaluation of betahistine generic medicinal products as a tool potentially determining the efficacy of pharmacotherapy]. Zh Nevrol Psikhiatr Im S S Korsakova 2018; 118:43-48. [PMID: 30585603 DOI: 10.17116/jnevro201811811143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To compare release parameters of various betahistine drugs in vitro using a comparative dissolution kinetics test. MATERIAL AND METHODS Objects of research are solid dosage forms (tablets) containing betahistine in a dose of 24 mg permitted for medical use in the Russian Federation. A method of comparative dissolution kinetics test was carried out as follows. The study was performed on a paddle stirrer at a speed of 50 rpm in three different pH dissolution media (pH 1.2, 4.5, 6.8), simulating the main sections of the digestive tract in which the active ingredient was decomposed, released and absorbed. This was performed in a quality controlled environment using a citrate buffer solution with pH 6.8. The time points for sampling the medium were 10 min, 15 min, 20 min and 30 min. RESULTS The results of betahistine release were significant (RSD<10%) for all time points, except the first time point (RSD<20%). Regardless of pH, there was a complete release (≥85% over 15 minutes, <10%) of betahistine from betaserc, 24 mg, tablets (manufactured by Mylan Laboratories SAS). The dissolution profiles of betahistine in other investigational drugs did not show complete drug release (parameter <85% in 15 minutes, <10%) in different pH media. Therefore, dissolution profiles of the studied drugs were not comparable to the reference profile. CONCLUSION Starting from 10 minutes, the reference drug of betahistine (betaserc, 24 mg) has a consistently higher release at different pH levels (representing the various stages of gastric digestion), vs. other studied generic analogues showing significantly lower levels of betahistine release. None of the studied drugs were found to be equivalent in vitro.
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Affiliation(s)
- S K Zyryanov
- Peoples' Friendship University of Russia, Medical Institute, Department of General and Clinical Pharmacology. Moscow, Russia
| | - O I Butranova
- Peoples' Friendship University of Russia, Medical Institute, Department of General and Clinical Pharmacology. Moscow, Russia
| | - G V Ramenskaya
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - G N Gildeeva
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - I E Shohin
- Center of Pharmaceutical Analytic Ltd., Moscow, Russia
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Tighilet B, Léonard J, Watabe I, Bernard-Demanze L, Lacour M. Betahistine Treatment in a Cat Model of Vestibular Pathology: Pharmacokinetic and Pharmacodynamic Approaches. Front Neurol 2018; 9:431. [PMID: 29942281 PMCID: PMC6005348 DOI: 10.3389/fneur.2018.00431] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 05/22/2018] [Indexed: 11/13/2022] Open
Abstract
This study is a pharmacokinetic (PK) and pharmacodynamics (PD) approach using betahistine doses levels in unilateral vestibular neurectomized cats (UVN) comparable to those used in humans for treating patients with Menière's disease. The aim is to investigate for the first time oral betahistine administration (0.2 and 2 mg/kg/day) with plasma concentrations of betahistine and its major metabolite 2-pyridylacetic acid (2-PAA) (N = 9 cats), the time course of posture recovery (N = 13 cats), and the regulation of the enzyme synthesizing histamine (histidine decarboxylase: HDC) in the tuberomammillary nuclei (TMN) of UVN treated animals (N = the same 13 cats plus 4 negative control cats). In addition the effect of co-administration of the lower betahistine dose (0.2 mg/kg/day) and selegiline (1 mg/kg/day), an inhibitor of the monamine oxidase B (MAOBi) implicated in betahistine catabolism was investigated. The PK parameters were the peak concentration (Cmax), the time when the maximum concentration is reached (Tmax) for both betahistine and 2-PAA and the area under the curve (AUC). The PD approach consisted at quantifying the surface support area, which is a good estimation of posture recovery. The plasma concentration-time-profiles of betahistine and 2-PAA in cats were characterized by early Cmax-values followed by a phase of rapid decrease of plasma concentrations and a final long lasting low level of plasma concentrations. Co administration of selegiline and betahistine increased values of Cmax and AUC up to 146- and 180-fold, respectively. The lowest dose of betahistine (0.2 mg/kg) has no effects on postural function recovery but induced an acute symptomatic effect characterized by a fast balance improvement (4–6 days). The higher dose (2 mg/kg) and the co-administration treatment induced both this acute effect plus a significant acceleration of the recovery process. The histaminergic activity of the neurons in the TMN was significantly increased under treatment with the 2 mg/kg betahistine daily dose, but not with the lower dose alone or in combination with selegiline. The results show for the first time that faster balance recovery in UVN treated cats is accompanied with high plasma concentrations of betahistine and 2-PAA, and upregulation of HDC immunopositive neurons in the TMN. The higher betahistine dose gives results similar to those obtained with the lower dose when co-administrated with an inhibitor of betahistine metabolism, selegiline. From a clinical point of view, the study provides new perspectives for Menière's disease treatment, regarding the daily betahistine dose that should be necessary for fast and slow metabolizers.
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Affiliation(s)
- Brahim Tighilet
- Aix-Marseille Université - Centre National de la Recherche Scientifique, Laboratoire de Neurosciences Sensorielles et Cognitives, UMR 7260, Physiopathologie et Thérapie des Désordres Vestibulaires, Centre Saint-Charles, Marseille, France
| | - Jacques Léonard
- Aix-Marseille Université - Centre National de la Recherche Scientifique, Laboratoire de Neurosciences Sensorielles et Cognitives, UMR 7260, Physiopathologie et Thérapie des Désordres Vestibulaires, Centre Saint-Charles, Marseille, France
| | - Isabelle Watabe
- Aix-Marseille Université - Centre National de la Recherche Scientifique, Laboratoire de Neurosciences Sensorielles et Cognitives, UMR 7260, Physiopathologie et Thérapie des Désordres Vestibulaires, Centre Saint-Charles, Marseille, France
| | - Laurence Bernard-Demanze
- Aix-Marseille Université - Centre National de la Recherche Scientifique, Laboratoire de Neurosciences Sensorielles et Cognitives, UMR 7260, Physiopathologie et Thérapie des Désordres Vestibulaires, Centre Saint-Charles, Marseille, France.,Service ORL et de Chirurgie Cervico-Faciale Hôpital de la Conception Marseille, Marseille, France
| | - Michel Lacour
- Aix-Marseille Université - Centre National de la Recherche Scientifique, Laboratoire de Neurosciences Sensorielles et Cognitives, UMR 7260, Physiopathologie et Thérapie des Désordres Vestibulaires, Centre Saint-Charles, Marseille, France
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Menière's disease: combined pharmacotherapy with betahistine and the MAO-B inhibitor selegiline-an observational study. J Neurol 2018. [PMID: 29532287 DOI: 10.1007/s00415-018-8809-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES Since oral betahistine has a very high first-pass effect (ca. 99%), metabolized by monoamine oxidases (MAO), the benefits of a high-dosage betahistine monotherapy were compared with those of a lower dosage of betahistine in combination with the MAO-B inhibitor (MAO-B) selegiline on the frequency of acute attacks of vertigo in patients with Menière's disease (MD). METHODS Thirteen adults aged 40-75 years (mean 58.9 years; six females) had initially been treated with a high dosage of betahistine dihydrochloride for at least 1 year. Under this therapy, all of them had ≤ 1 attack for ≥ 3 months prior to the combination pharmacotherapy. Subsequently, they received 5 mg/day selegiline and the dosage of betahistine was reduced to about one tenth and then individually adjusted to the dosage needed to achieve the same treatment response (≤ 1 per 3 months, observational period of at least 6 months). RESULTS The initial dosage for the long-term "titration" of the attacks of vertigo was 9-80 24-mg tablets/day (mean 37.3), i.e. 216-1920 mg/day (mean 895.4 mg/day). After the combination with selegiline, the dosage needed to achieve the same benefit for ≥ 3 months was 3-36 24-mg tablets (mean 8.5), i.e., 72-864 mg/day [mean 204.9 mg/day, p < 0.001 (paired t test)]. One patient transiently stopped the treatment with selegiline, another one reduced the dosage to 2.5 mg/day and the attacks re-occurred after 2-4 weeks. Six out of 13 patients reported transient fullness of the head during the combined treatment; in 2 of them this went away when they switched to 2.5 mg bid. In the longer term (> 9 months), one patient had to increase the selegiline dosage to 5 mg bd, one patient stopped the treatment with selegiline. CONCLUSIONS The achievement of the same clinical effect with a significantly lower (about 1/5) dosage of betahistine can be explained by the inhibition of the MAO-B by selegiline leading to higher serum concentrations of betahistine. This approach is in line with recent developments to bypass the first-pass effect of betahistine by transbuccal or intranasal application. Despite the substantial methodological limitations of such an observational study, this combined pharmacotherapy could be an alternative to a high-dosage monotherapy with betahistine of MD.
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Fukushima M, Kitahara T, Oya R, Akahani S, Inohara H, Naganawa S, Takeda N. Longitudinal up-regulation of endolymphatic hydrops in patients with Meniere's disease during medical treatment. Laryngoscope Investig Otolaryngol 2017; 2:344-350. [PMID: 29299506 PMCID: PMC5743151 DOI: 10.1002/lio2.115] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 07/31/2017] [Accepted: 09/16/2017] [Indexed: 12/13/2022] Open
Abstract
Objective/Hypothesis Meniere's disease (MD) is a common inner ear disease characterized by repeated episodic vertigo, fluctuating sensorineural hearing loss, and tinnitus. Its pathology is defined as endolymphatic hydrops (EH) in the inner ear and EH has been hypothesized to correlate with the clinical symptoms of MD. We presented the dynamics of in vivo EH in MD patients during medical treatments. Study Design Prospective, single-arm repeated measures. Methods Eleven MD patients were enrolled. All subjects prospectively underwent gadolinium-enhanced inner ear magnetic resonance (MR) imaging and neuro-otological testing before and after medical treatment. The volume of EH was quantitatively evaluated by processing MR images. All MD patients were administered continuous medication and followed up for more than 12 months. Results The frequency of vertigo episodes decreased in all patients and vestibular function decreased to 13-91% of the pre-treatment level. The volume ratio of post-treatment EH-to-pre-treatment EH ranged from 1.01-3.22. The total volume of pre-treatment EH was significantly correlated with cochlear symptom disease duration and the affected ear's hearing level. Conclusion EH in MD patients developed longitudinally with deterioration of inner ear function during medical treatment. The natural course of MD may progress with development of EH at least for a certain period. Level of Evidence 2b.
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Affiliation(s)
- Munehisa Fukushima
- Department of Otolaryngology and Head and Neck Surgery Kansai Rosai Hospital Hyogo Japan.,Department of Otolaryngology and Head and Neck Surgery Osaka University, Graduate School of Medicine Osaka Japan
| | - Tadashi Kitahara
- Department of Otolaryngology and Head and Neck Surgery Nara Medical University Nara Japan
| | - Ryohei Oya
- Department of Otolaryngology and Head and Neck Surgery Osaka University, Graduate School of Medicine Osaka Japan
| | - Shiro Akahani
- Department of Otolaryngology and Head and Neck Surgery Kansai Rosai Hospital Hyogo Japan
| | - Hidenori Inohara
- Department of Otolaryngology and Head and Neck Surgery Osaka University, Graduate School of Medicine Osaka Japan
| | - Shinji Naganawa
- Department of Radiology Nagoya University Graduate School of Medicine Aichi Japan
| | - Noriaki Takeda
- Department of Otolaryngology University of Tokushima School of Medicine Tokushima Japan
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Bertlich M, Ihler F, Weiss BG, Freytag S, Strupp M, Jakob M, Canis M. Role of capillary pericytes and precapillary arterioles in the vascular mechanism of betahistine in a guinea pig inner ear model. Life Sci 2017; 187:17-21. [DOI: 10.1016/j.lfs.2017.08.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 08/03/2017] [Accepted: 08/14/2017] [Indexed: 10/19/2022]
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Fingolimod (FTY-720) is Capable of Reversing Tumor Necrosis Factor Induced Decreases in Cochlear Blood Flow. Otol Neurotol 2017; 38:1213-1216. [DOI: 10.1097/mao.0000000000001510] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Drug-induced Defibrinogenation as New Treatment Approach of Acute Hearing Loss in an Animal Model for Inner Ear Vascular Impairment. Otol Neurotol 2017; 38:648-654. [DOI: 10.1097/mao.0000000000001400] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Krishnamoorthy G, Reimann K, Wangemann P. Ryanodine-induced vasoconstriction of the gerbil spiral modiolar artery depends on the Ca 2+ sensitivity but not on Ca 2+ sparks or BK channels. BMC PHYSIOLOGY 2016; 16:6. [PMID: 27806708 PMCID: PMC5093982 DOI: 10.1186/s12899-016-0026-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 10/13/2016] [Indexed: 01/26/2023]
Abstract
Background In many vascular smooth muscle cells (SMCs), ryanodine receptor-mediated Ca2+ sparks activate large-conductance Ca2+-activated K+ (BK) channels leading to lowered SMC [Ca2+]i and vasodilation. Here we investigated whether Ca2+ sparks regulate SMC global [Ca2+]i and diameter in the spiral modiolar artery (SMA) by activating BK channels. Methods SMAs were isolated from adult female gerbils, loaded with the Ca2+-sensitive flourescent dye fluo-4 and pressurized using a concentric double-pipette system. Ca2+ signals and vascular diameter changes were recorded using a laser-scanning confocal imaging system. Effects of various pharmacological agents on Ca2+ signals and vascular diameter were analyzed. Results Ca2+ sparks and waves were observed in pressurized SMAs. Inhibition of Ca2+ sparks with ryanodine increased global Ca2+ and constricted SMA at 40 cmH2O but inhibition of Ca2+ sparks with tetracaine or inhibition of BK channels with iberiotoxin at 40 cmH2O did not produce a similar effect. The ryanodine-induced vasoconstriction observed at 40 cmH2O was abolished at 60 cmH2O, consistent with a greater Ca2+-sensitivity of constriction at 40 cmH2O than at 60 cmH2O. When the Ca2+-sensitivity of the SMA was increased by prior application of 1 nM endothelin-1, ryanodine induced a robust vasoconstriction at 60 cmH2O. Conclusions The results suggest that Ca2+ sparks, while present, do not regulate vascular diameter in the SMA by activating BK channels and that the regulation of vascular diameter in the SMA is determined by the Ca2+-sensitivity of constriction.
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Affiliation(s)
- Gayathri Krishnamoorthy
- Anatomy & Physiology Department, Cell Physiology Laboratory, Kansas State University, 228 Coles Hall, Manhattan, Kansas, 66506-5802, USA
| | - Katrin Reimann
- Anatomy & Physiology Department, Cell Physiology Laboratory, Kansas State University, 228 Coles Hall, Manhattan, Kansas, 66506-5802, USA.,Department of Otolaryngology-Head and Neck Surgery, Tübingen Hearing Research Centre, and Molecular Physiology of Hearing, University of Tübingen, Tübingen, Germany
| | - Philine Wangemann
- Anatomy & Physiology Department, Cell Physiology Laboratory, Kansas State University, 228 Coles Hall, Manhattan, Kansas, 66506-5802, USA.
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Abstract
BACKGROUND Vertigo is a symptom in which individuals experience a false sensation of movement. This type of dizziness is thought to originate in the inner ear labyrinth or its neural connections. It is a commonly experienced symptom and can cause significant problems with carrying out normal activities. Betahistine is a drug that may work by improving blood flow to the inner ear. This review examines whether betahistine is more effective than a placebo at treating symptoms of vertigo from different causes. OBJECTIVES To assess the effects of betahistine in patients with symptoms of vertigo from different causes. SEARCH METHODS The Cochrane ENT Information Specialist searched the Cochrane ENT Trials Register; Central Register of Controlled Trials (CENTRAL 2015, Issue 8); PubMed; EMBASE; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. We also contacted manufacturers and researchers in the field. The date of the search was 21 September 2015. SELECTION CRITERIA We included randomised controlled trials of betahistine versus placebo in patients of any age with vertigo from any neurotological diagnosis in any settings. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. Our primary outcome was the proportion of patients with reduction in vertigo symptoms (considering together the intensity, frequency and duration those symptoms). MAIN RESULTS We included 17 studies, with a total of 1025 participants; 12 studies were published (567 patients) and five were unpublished (458 patients). Sixteen studies including 953 people compared betahistine with placebo. All studies with analysable data lasted three months or less. The majority were at high risk of bias, but in some the risk of bias was unclear. One study, at high risk of bias, included 72 people with benign paroxysmal positional vertigo (BPPV) and compared betahistine with placebo; all patients also had particle repositioning manoeuvres. The studies varied considerably in terms of types of participants, their diagnoses, the dose of betahistine and the length of time it was taken for, the study methods and the way any improvement in vertigo symptoms was measured. Using the GRADE system, we judged the quality of evidence overall to be low for two outcomes (proportion of patients with improvement and proportion with adverse events).Pooled data showed that the proportion of patients reporting an overall reduction in their vertigo symptoms was higher in the group treated with betahistine than the placebo group: risk ratio (RR) 1.30, 95% confidence interval (CI) 1.05 to 1.60; 606 participants; 11 studies). This result should be interpreted with caution as the test for statistical heterogeneity as measured by the I(2) value was high.Adverse effects (mostly gastrointestinal symptoms and headache) were common but medically serious events in the study were rare and isolated: there was no difference in the frequency of adverse effects between the betahistine and placebo groups, where the rates were 16% and 15% respectively (weighted values, RR 1.03, 95% CI 0.76 to 1.40; 819 participants; 12 studies).Sixteen per cent of patients from both the betahistine and the placebo groups withdrew (dropped out) from the studies (RR 0.96, 95% CI 0.65 to 1.42; 481 participants; eight studies).Three studies looked at objective vestibular function tests as an outcome; the numbers of participants were small, techniques of measurement very diverse and reporting details sparse, so analysis of this outcome was inconclusive.We looked for information on generic quality of life and falls, but none of the studies reported on these outcomes. AUTHORS' CONCLUSIONS Low quality evidence suggests that in patients suffering from vertigo from different causes there may be a positive effect of betahistine in terms of reduction in vertigo symptoms. Betahistine is generally well tolerated with a low risk of adverse events. Future research into the management of vertigo symptoms needs to use more rigorous methodology and include outcomes that matter to patients and their families.
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Affiliation(s)
- Louisa Murdin
- Ear Institute, Faculty of Brain Sciences, University College London, London, UK
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Abstract
Meniere's disease (MD) is a disorder of the inner ear that causes vertigo attacks, fluctuating hearing loss, tinnitus and aural fullness. The aetiology of MD is multifactorial. A characteristic sign of MD is endolymphatic hydrops (EH), a disorder in which excessive endolymph accumulates in the inner ear and causes damage to the ganglion cells. In most patients, the clinical symptoms of MD present after considerable accumulation of endolymph has occurred. However, some patients develop symptoms in the early stages of EH. The reason for the variability in the symptomatology is unknown and the relationship between EH and the clinical symptoms of MD requires further study. The diagnosis of MD is based on clinical symptoms but can be complemented with functional inner ear tests, including audiometry, vestibular-evoked myogenic potential testing, caloric testing, electrocochleography or head impulse tests. MRI has been optimized to directly visualize EH in the cochlea, vestibule and semicircular canals, and its use is shifting from the research setting to the clinic. The management of MD is mainly aimed at the relief of acute attacks of vertigo and the prevention of recurrent attacks. Therapeutic options are based on empirical evidence and include the management of risk factors and a conservative approach as the first line of treatment. When medical treatment is unable to suppress vertigo attacks, intratympanic gentamicin therapy or endolymphatic sac decompression surgery is usually considered. This Primer covers the pathophysiology, symptomatology, diagnosis, management, quality of life and prevention of MD.
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Albu S, Nagy A, Doros C, Marceanu L, Cozma S, Musat G, Trabalzini F. Treatment of Meniere's disease with intratympanic dexamethazone plus high dosage of betahistine. Am J Otolaryngol 2016; 37:225-30. [PMID: 27178513 DOI: 10.1016/j.amjoto.2015.12.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 12/07/2015] [Accepted: 12/23/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of the present study was to assess if the combined therapy of intratympanic dexamethasone (ITD) and high dosage of betahistine (HDBH) is able to provide increased vertigo control compared to ITD alone in patients suffering from definite unilateral Meniere's disease (MD). MATERIALS AND METHODS Consecutive MD patients were enrolled and randomly divided in two groups, each comprising 33 cases. Group A received a combination of ITD and identical-appearing placebo pills while Group B received a combination of ITD and HDBH. ITD protocol consisted of three consecutive daily injections. HDBH comprised 144mg/day (48mg tid). The main outcome measures were: 1) vertigo class, pure tone average (PTA), speech discrimination score (SDS) and Functional Level Score (FLS) according to the American Academy of Otolaryngology-Head and Neck Surgery criteria; 2) complete and substantial vertigo control according to the Kaplan-Meier survival method. RESULTS Sixty two patients completed the 24-month follow-up. A complete vertigo control was achieved in 14 patients (44%) from Group A and in 22 patients (73.3%) from Group B, statistically significant (p=0.01). Complete vertigo relief is also significant according to the Kaplan-Meier method: p=0.027, log rank test. Substantial vertigo control was obtained in 21 patients (65.6%) in Group A and 27 patients (90%) in Group B. The difference is statistically significant, p=0.02. The difference is significant according to the Kaplan-Meier method: p=0.035, log rank test. No significant differences between hearing levels and tinnitus scores were demonstrated between the groups. CONCLUSIONS Our preliminary results demonstrate that complete and substantial vertigo control is significantly higher in patients treated with a combination of HDBH and ITD.
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Affiliation(s)
- Silviu Albu
- II-nd Department of Otolaryngology, Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca Cluj-Napoca, Romania; RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania.
| | - Alina Nagy
- RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
| | - Caius Doros
- Department of Otolaryngology, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania
| | | | - Sebastian Cozma
- Department of Otolaryngology, Grigore T. Popa University of Medicine and Pharmacy Iasi, Iasi, Romania
| | - Gabriela Musat
- Department of Otolaryngology, Sf. Maria Hospital Bucuresti, Romania
| | - Franco Trabalzini
- Otology and Skull Base Surgery Unit, Siena University Hospital, Siena, Italy
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Shah S, Ignatius A, Ahsan S. It is 2015: What are the best diagnostic and treatment options for Ménière’s disease? World J Otorhinolaryngol 2016; 6:1-12. [DOI: 10.5319/wjo.v6.i1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 10/22/2015] [Accepted: 12/08/2015] [Indexed: 02/06/2023] Open
Abstract
Ménière’s disease (MD) is a common cause of recurrent vertigo. Its pathophysiology is still unclear and controversial. The most common histological finding in postmortem temporal bone studies of patients is endolymphatic hydrops (EH). However, not all cases of hydrops are associated with MD and it may represent the end point of various etiologies. The diagnostic criteria for MD have undergone changes during the past few decades. A recent collaboration among specialty societies in United States, Europe and Japan has given rise to a new set of guidelines for the diagnosis and classification of MD. The aim is to develop international consensus criteria for MD that would help improve the quality of data collected from patients. The diagnosis of MD can be difficult in some cases as there is no gold standard for testing. Previous use of audiometric data and electrocochleography are poorly sensitive as screening tools. Recently magnetic resonance imaging as a diagnostic tool for identifying EH has gained popularity in Asia and Europe. Vestibular evoked myogenic potentials are also used but lack specificity. Finally, the treatment for MD has improved with the introduction of intratympanic treatments with steroids and gentamicin as well as less invasive treatment with the Meniett device.
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Adrion C, Fischer CS, Wagner J, Gürkov R, Mansmann U, Strupp M. Efficacy and safety of betahistine treatment in patients with Meniere's disease: primary results of a long term, multicentre, double blind, randomised, placebo controlled, dose defining trial (BEMED trial). BMJ 2016; 352:h6816. [PMID: 26797774 PMCID: PMC4721211 DOI: 10.1136/bmj.h6816] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
STUDY QUESTION What is the long term efficacy of betahistine dihydrochloride on the incidence of vertigo attacks in patients with Meniere's disease, compared with placebo? METHODS The BEMED trial is a multicentre, double blind, randomised, placebo controlled, three arm, parallel group, phase III, dose defining superiority trial conducted in 14 German tertiary referral centres (for neurology or ear, nose, and throat). Adults aged 21-80 years (mean age 56 years) with definite unilateral or bilateral Meniere's disease were recruited from March 2008 to November 2012. Participants received placebo (n=74), low dose betahistine (2 × 24 mg daily, (n=73)), or high dose betahistine (3 × 48 mg daily, (n=74)) over nine months. The primary outcome was the number of attacks per 30 days, based on patients' diaries during a three month assessment period at months seven to nine. An internet based randomisation schedule performed a concealed 1:1:1 allocation, stratified by study site. Secondary outcomes included the duration and severity of attacks, change in quality of life scores, and several observer-reported parameters to assess changes in audiological and vestibular function. STUDY ANSWER AND LIMITATIONS Incidence of attacks related to Meniere's disease did not differ between the three treatment groups (P=0.759). Compared with placebo, attack rate ratios were 1.036 (95% confidence interval 0.942 to 1.140) and 1.012 (0.919 to 1.114) for low dose and high dose betahistine, respectively. The overall monthly attack rate fell significantly by the factor 0.758 (0.705 to 0.816; P<0.001). The population based, mean monthly incidence averaged over the assessment period was 2.722 (1.304 to 6.309), 3.204 (1.345 to 7.929), and 3.258 (1.685 to 7.266) for the placebo, low dose betahistine, and high dose betahistine groups, respectively. Results were consistent for all secondary outcomes. Treatment was well tolerated with no unexpected safety findings. Without a control group of patients who did not receive any intervention to follow the natural course of the disease, the placebo effect could not be accurately assessed and differentiated from spontaneous remission and fluctuation of symptoms. WHAT THIS STUDY ADDS Current evidence is limited as to whether betahistine prevents vertigo attacks caused by Meniere's disease, compared with placebo. The trial provides information on symptom relief on placebo intervention which is relevant for the design of future studies on potential disease modifying treatments in patients with Meniere's disease. FUNDING, COMPETING INTERESTS, DATA SHARING Support from the German Federal Ministry of Education and Research (BMBF support code 01KG0708). Potential competing interests have been reported in full at the end of the paper on thebmj.com. Data are available from the corresponding author (Michael.Strupp@med.uni-muenchen.de) or biostatistician (mansmann@ibe.med.uni-muenchen.de). Study registration EudraCT no 2005-000752-32; ISRCTN no ISRCTN44359668.
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Affiliation(s)
- Christine Adrion
- German Center for Vertigo and Balance Disorders, University Hospital Munich, Campus Grosshadern, Munich, Germany Institute for Medical Informatics, Biometry, and Epidemiology, University of Munich, Campus Grosshadern
| | - Carolin Simone Fischer
- German Center for Vertigo and Balance Disorders, University Hospital Munich, Campus Grosshadern, Munich, Germany
| | - Judith Wagner
- Department of Neurology, University Hospital Munich, 81377 Munich
| | - Robert Gürkov
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Munich
| | - Ulrich Mansmann
- Institute for Medical Informatics, Biometry, and Epidemiology, University of Munich, Campus Grosshadern
| | - Michael Strupp
- German Center for Vertigo and Balance Disorders, University Hospital Munich, Campus Grosshadern, Munich, Germany Department of Neurology, University Hospital Munich, 81377 Munich
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Abstract
Menière's disease (MD) is a chronic multifactorial disorder of the inner ear characterized by episodic vestibular symptoms associated with sensorineural hearing loss, tinnitus, and aural pressure. Epidemiologic and genomic evidence supports a genetic susceptibility with multiple biochemical pathways involved, including the endocrine system, innate immune response, and autonomic nervous system. Allergens, infectious agents, vascular events, or genetic factors could modify inner-ear homeostasis and trigger MD. The diagnosis of MD is based on clinical criteria and requires the observation of an episodic vertigo syndrome associated with low- to medium-frequency sensorineural hearing loss and fluctuating aural symptoms (hearing loss, tinnitus, and/or fullness) in the affected ear. Headache is also found during the attacks and bilateral involvement is found in 25-40% of cases. Audiologic and vestibular assessment is recommended to monitor the clinical course. The treatment of MD is symptomatic to obtain relief of vestibular episodes and preventive to limit hearing loss progression. Treatment options include sodium restriction, betahistine, intratympanic gentamicin, or steroids and eventually surgery, such as cochlear implantation.
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Affiliation(s)
- J M Espinosa-Sanchez
- Otology and Neurotology Group, Department of Genomic Medicine, Centre for Genomics and Oncological Research (GENYO), Pfizer-University of Granada-Junta de Andalucia, Granada, Spain; Department of Otolaryngology, Hospital San Agustin, Linares, Jaen, Spain
| | - J A Lopez-Escamez
- Otology and Neurotology Group, Department of Genomic Medicine, Centre for Genomics and Oncological Research (GENYO), Pfizer-University of Granada-Junta de Andalucia, Granada, Spain; Department of Otolaryngology, Complejo Hospitalario Universitario de Granada, Granada, Spain.
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Strupp M, Dieterich M, Zwergal A, Brandt T. [Peripheral, central and functional vertigo syndromes]. DER NERVENARZT 2015; 86:1573-84; quiz 1585-6. [PMID: 26643594 DOI: 10.1007/s00115-015-4425-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Depending on the temporal course, three forms of vertigo syndrome can be differentiated: 1) vertigo attacks, e.g. benign paroxysmal positional vertigo (BPPV), Menière's disease and vestibular migraine, 2) acute spontaneous vertigo lasting for days, e.g. acute unilateral vestibulopathy, brainstem or cerebellar infarction and 3) symptoms lasting for months or years, e.g. bilateral vestibulopathy and functional vertigo. The specific therapy of the various syndromes is based on three principles: 1) physical treatment with liberatory maneuvers for BPPV and balance training for vestibular deficits, 2) pharmacotherapy, e.g. for acute unilateral vestibulopathy (corticosteroids) and Menière's disease (transtympanic administration of gentamicin or steroids and high-dose betahistine therapy); placebo-controlled pharmacotherapy studies are currently being carried out for acute unilateral vestibulopathy, vestibular paroxysmia, prophylaxis of BPPV, vestibular migraine, episodic ataxia type 2 and cerebellar ataxia; 3) psychotherapy for functional dizziness.
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Affiliation(s)
- M Strupp
- Neurologische Klinik, Klinikum der Universität München, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland. .,Deutsches Schwindel- und Gleichgewichtszentrum, Klinikum der Universität München, Campus Großhadern, München, Deutschland.
| | - M Dieterich
- Neurologische Klinik, Klinikum der Universität München, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland.,Deutsches Schwindel- und Gleichgewichtszentrum, Klinikum der Universität München, Campus Großhadern, München, Deutschland.,SyNergy, Munich Cluster for Systems Neurology, München, Deutschland
| | - A Zwergal
- Neurologische Klinik, Klinikum der Universität München, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland.,Deutsches Schwindel- und Gleichgewichtszentrum, Klinikum der Universität München, Campus Großhadern, München, Deutschland
| | - T Brandt
- Deutsches Schwindel- und Gleichgewichtszentrum, Klinikum der Universität München, Campus Großhadern, München, Deutschland.,Institut für Klinische Neurowissenschaften, Klinikum der Universität München, Campus Großhadern, München, Deutschland
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Møller MN, Kirkeby S, Vikeså J, Nielsen FC, Caye-Thomasen P. Expression of histamine receptors in the human endolymphatic sac: the molecular rationale for betahistine use in Menieres disease. Eur Arch Otorhinolaryngol 2015. [DOI: 10.1007/s00405-015-3731-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Strupp M, Zwergal A, Feil K, Bremova T, Brandt T. Pharmacotherapy of vestibular and cerebellar disorders and downbeat nystagmus: translational and back-translational research. Ann N Y Acad Sci 2015; 1343:27-36. [PMID: 25903394 DOI: 10.1111/nyas.12774] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
There are currently eight groups of drugs for the pharmacotherapy of vertigo, nystagmus, and cerebellar disorders: antiemetics; anti-inflammatories, antimenieres, and antimigraineous medications; antidepressants, anticonvulsants, aminopyridines, and acetyl-DL-leucine ("the eight A's"). In acute unilateral vestibulopathy, corticosteroids improve the recovery of peripheral vestibular function, but there is not sufficient current evidence for a general recommendation. There is also insufficient evidence that 48 or 144 mg/day betahistine has an effect in Ménière's disease. Therefore, higher dosages are currently recommended; in animal studies, it was shown that betahistine increases cochlear blood flow. In vestibular paroxysmia, oxcarbazepine was effective (one yet not randomized controlled trial (RCT)). Aminopyridines are recommended for the treatment of downbeat nystagmus (two RCTs) and episodic ataxia type 2 (EA2, one RCT). There are so far no RCTs on vestibular migraine, so currently no treatment can be recommended. Acetyl-dl-leucine improves cerebellar ataxia (three observational studies); it also accelerates central compensation in an animal model of acute unilateral lesion, but RCTs were negative. There are ongoing RCTs on vestibular paroxysmia with carbamazepine (VESPA), acute unilateral vestibulopathy with betahistine (BETAVEST), vestibular migraine with metoprolol (PROVEMIG), benign paroxysmal positional vertigo with vitamin D (VitD@BPPV), EA2 with 4-aminopyridine versus acetazolamide (EAT-2-TREAT), and cerebellar ataxias with acetyl-DL-leucine (ALCAT).
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Affiliation(s)
- Michael Strupp
- Department of Neurology, German Center for Vertigo and Balance Disorders and Institute for Clinical Neurosciences, University Hospital Munich, Campus Grosshadern, Munich, Germany
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Moorthy G, Sallee F, Gabbita P, Zemlan F, Sallans L, Desai PB. Safety, tolerability and pharmacokinetics of 2-pyridylacetic acid, a major metabolite of betahistine, in a phase 1 dose escalation study in subjects with ADHD. Biopharm Drug Dispos 2015; 36:429-39. [DOI: 10.1002/bdd.1955] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 03/03/2015] [Accepted: 04/18/2015] [Indexed: 11/12/2022]
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Two-photon microscopy allows imaging and characterization of cochlear microvasculature in vivo. BIOMED RESEARCH INTERNATIONAL 2015; 2015:154272. [PMID: 25883941 PMCID: PMC4390612 DOI: 10.1155/2015/154272] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 02/26/2015] [Accepted: 03/02/2015] [Indexed: 11/18/2022]
Abstract
Impairment of cochlear blood flow has been discussed as factor in the pathophysiology of various inner ear disorders. However, the microscopic study of cochlear microcirculation is limited due to small scale and anatomical constraints. Here, two-photon fluorescence microscopy is applied to visualize cochlear microvessels. Guinea pigs were injected with Fluorescein isothiocyanate- or Texas red-dextrane as plasma marker. Intravital microscopy was performed in four animals and explanted cochleae from four animals were studied. The vascular architecture of the cochlea was visualized up to a depth of 90.0±22.7 μm. Imaging yielded a mean contrast-to-noise ratio (CNR) of 3.3±1.7. Mean diameter in vivo was 16.5±6.0 μm for arterioles and 8.0±2.4 μm for capillaries. In explanted cochleae, the diameter of radiating arterioles and capillaries was measured with 12.2±1.6 μm and 6.6±1.0 μm, respectively. The difference between capillaries and arterioles was statistically significant in both experimental setups (P<0.001 and P=0.022, two-way ANOVA). Measured vessel diameters in vivo and ex vivo were in agreement with published data. We conclude that two-photon fluorescence microscopy allows the investigation of cochlear microvessels and is potentially a valuable tool for inner ear research.
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Ishiyama G, Lopez IA, Sepahdari AR, Ishiyama A. Meniere's disease: histopathology, cytochemistry, and imaging. Ann N Y Acad Sci 2015; 1343:49-57. [DOI: 10.1111/nyas.12699] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Gail Ishiyama
- Department of Neurology; Reed Neurological Research Center; David Geffen School of Medicine at UCLA; Los Angeles California
| | - Ivan A. Lopez
- Department of Head and Neck Surgery; Department of Surgery; David Geffen School of Medicine at UCLA; Los Angeles California
| | - Ali R. Sepahdari
- Department of Radiology; David Geffen School of Medicine at UCLA; Los Angeles California
| | - Akira Ishiyama
- Department of Head and Neck Surgery; Department of Surgery; David Geffen School of Medicine at UCLA; Los Angeles California
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Abstract
OPINION STATEMENT Diagnosis of Menière's disease is made with a characteristic patient history, including discrete episodes of vertigo lasting 20 min or longer, accompanied by sensorineural hearing loss, which is typically low frequency at first, aural fullness, and tinnitus. Workup includes audiometry, a contrast enhanced MRI of the internal auditory canals, and exclusion of other diseases that can produce similar symptoms, like otosyphilis, autoimmune inner ear disease, perilymphatic fistula, superior semicircular canal syndrome, Lyme disease, multiple sclerosis, vestibular paroxysmia, and temporal bone tumors. A history of migraine should be sought as well because of a high rate of co-occurrence (Rauch, Otolaryngol Clin North Am 43:1011-1017, 2010). Treatment begins with conservative measures, including low salt diet, avoidance of stress and caffeine, and sleep hygiene. Medical therapy with a diuretic is the usual next step. If that fails to control symptoms, then the options of intratympanic (IT) steroids and betahistine are discussed. Next tier treatments include the Meniett device and endolymphatic sac surgery, but the efficacy of both is controversial. If the above measures fail to provide symptomatic control of vertigo, then ablative therapies like intratympanic gentamicin are considered. Rarely, vestibular nerve section or labyrinthectomy is considered for a patient with severe symptoms who does not show a reduction in vestibular function with gentamicin. Benzodiazepines and anti-emetics are used for symptomatic control during vertigo episodes. Rehabilitative options for unilateral vestibular weakness include physical therapy and for unilateral hearing loss include conventional hearing aids, contralateral routing of sound (CROS) and osseointegrated hearing aids.
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Affiliation(s)
- Jeffrey D Sharon
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA,
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Intratympanic dexamethasone versus high dosage of betahistine in the treatment of intractable unilateral Meniere disease. Am J Otolaryngol 2015; 36:205-9. [PMID: 25510210 DOI: 10.1016/j.amjoto.2014.10.032] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 10/21/2014] [Accepted: 10/25/2014] [Indexed: 11/23/2022]
Abstract
PURPOSE The objective of our randomized, double-blind study was to compare the effectiveness of intratympanic (IT) dexamethasone versus high-dosage of betahistine in the treatment of patients with intractable unilateral Meniere disease (MD). MATERIALS AND METHODS Sixty six patients with definite unilateral MD were randomly divided in two groups: Group A received a combination of IT dexamethasone (DX) and identical-appearing placebo pills while Group B received a combination of high-dosage betahistine and IT saline. Intratympanic injections were repeated for three times with an interlude of 3days. High-dosage of betahistine entailed 144mg/day. Mean outcome measures consisted of vertigo control, pure tone average (PTA), speech discrimination score, Functional Level Score, Dizziness Handicap Inventory and Tinnitus Handicap Inventory. RESULTS Fifty nine patients completed the study and were available at 12months for analysis. In Group A complete vertigo control (class A) was attained in 14 patients (46.6%) and substantial control (class B) in 7 patients (20%). In Group B, 12 patients (41%) achieved complete vertigo control (class A), 5 patients (17%) substantial control (class B). There is no statistical difference in vertigo control between the two treatment groups. In Group A hearing was unchanged in 14 patients and improved in 4 patients, while in Group B hearing was unchanged in 16 patients and improved in 2 patients. CONCLUSIONS Our preliminary results demonstrate that high-dosage of betahistine achieved similar outcomes as IT dexamethasone in the control of vertigo and hearing preservation.
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Abstract
Confusion in the nomenclature of Ménière's disease and lack of a standard definition of the disorder until 1995 has hampered accurate assessment of treatment efficacy since the presently defined disorder was first described in 1938. The lack of a widely accepted mechanism of the disease has also delayed the development of rational treatments. Past treatments have focused on relieving elevated pressures in the hydropic ear and more recently on treatment of underlying migraine. Present dietary methods of control include sodium restriction and migraine trigger elimination. Pharmacologic treatments include diuretics, migraine prophylactic medications, histamine analogs, and oral steroids. Surgical procedures include intratympanic steroid perfusion, shunts, and ablative procedures when conservative treatments fail. External pressure devices are also used. Evidence of efficacy is lacking for most interventions other than ablation. At our institution, Ménière's disease is treated as a cerebrovascular disorder. Control of risk factors for cerebrovascular ischemia is combined with treatment of pressure dysfunction in the hydropic ear. Screening for risk factors is performed at presentation. Migraine, dyslipidemia, obesity, diabetes, sleep apnea, hypertension, and atherosclerosis are among the major factors that often require medical management. Migraine prophylactic medications, magnesium supplementation, sodium restriction, migraine trigger elimination, diuretics, anticoagulants, and antihypertensives are among the treatments used initially. Steroids administered orally or intratympanically are used if control is not achieved medically, and ablation remains the definitive treatment in unilateral cases experiencing treatment failure.
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Affiliation(s)
- Carol A Foster
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, Colorado, USA
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Aksoy F, Dogan R, Ozturan O, Yildirim YS, Veyseller B, Yenigun A, Ozturk B. Betahistine exacerbates amikacin ototoxicity. Ann Otol Rhinol Laryngol 2014; 124:280-7. [PMID: 25358613 DOI: 10.1177/0003489414557020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Betahistine augments cochlear blood flow and is currently used as an efficient therapeutic agent. Amikacin is used in a wide range of areas, but its ototoxic effect continues to be problematic. This study investigates the effect of betahistine on amikacin-induced ototoxicity. METHODS Thirty-two healthy rats were randomized to 4 groups of 8 rats in each group (amikacin, amikacin+betahistine, betahistine, and no treatment). Amikacin was administered intramuscularly to groups 1 and 2 for 14 days. Betahistine was delivered by oral gavage to groups 2 and 3 for 21 days. Distortion-product otoacoustic emissions (DPOAE) and auditory brainstem response (ABR) tests were conducted on all rats. RESULTS There were significant decreases in the DPOAE levels and significant increases in the ABR thresholds of the amikacin and amikacin+betahistine groups on the 7th, 14th, and 21st days, as compared to their basal values. The DPOAE levels of the amikacin+betahistine group significantly decreased on days 7, 14, and 21, and the ABR thresholds significantly increased on the same days, as compared to the amikacin group. CONCLUSION Our study implies that amikacin's ototoxic effects are augmented by the concurrent use of betahistine. Experimental and clinical research, supported by histopathological studies, is needed to affirm our findings.
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Affiliation(s)
- Fadlullah Aksoy
- Bezmialem Vakif University, Department of Otorhinolaryngology, Fatih, Istanbul, Turkey
| | - Remzi Dogan
- Bayrampasa State Hospital, Department of Otorhinolaryngology, Bayrampasa, Istanbul, Turkey
| | - Orhan Ozturan
- Bezmialem Vakif University, Department of Otorhinolaryngology, Fatih, Istanbul, Turkey
| | - Yavuz Selim Yildirim
- Bezmialem Vakif University, Department of Otorhinolaryngology, Fatih, Istanbul, Turkey
| | - Bayram Veyseller
- Bezmialem Vakif University, Department of Otorhinolaryngology, Fatih, Istanbul, Turkey
| | - Alper Yenigun
- Karaman State Hospital, Department of Otorhinolaryngology, Karaman, Turkey
| | - Burak Ozturk
- Bezmialem Vakif University, Faculty of Health Sciences, Department of Audiology, Fatih, Istanbul, Turkey
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