DÄ internationalArchive43/2008Diagnosis and Treatment of Vertigo and Dizziness: Endolymphatic Hydrops

Correspondence

Diagnosis and Treatment of Vertigo and Dizziness: Endolymphatic Hydrops

Dtsch Arztebl Int 2008; 105(43): 747. DOI: 10.3238/arztebl.2008.0747b

Hesse, G

LNSLNS We thank neurologists Strupp and Brandt for their review article on the diagnosis and treatment of vertigo and dizziness.

Psychogenic vertigo and dizziness cannot be adequately described by categorizing them as "phobic swaying vertigo." Along with Eckhardt-Henn et al. (1), we rather think that most cases can be diagnosed as anxiety, depression, and somatization disorder.

We also take a more nuanced view of the incidence and treatment of Menière's disease:

The diagnosis of Menière's disease certainly requires more than merely noting down a patient's report of the symptom triad of dizziness, hearing loss, and tinnitus. Without a suitably thorough clinical examination, no precise data on the incidence and prevalence of Menière's disease can be obtained; nor, for that matter, can the physician deliver any well-founded prognosis for the development of bilateral Menière's disease.

We are quite surprised, too, by the recommendation of long-term treatment with betahistine, in the light of our many years of clinical experience. This recommendation, it seems to us, stands on shaky legs.

The pilot study of Strupp et al. lacks not only a control group, but also the long follow-up period that would be appropriate for a study of Menière's disease. In addition, the study does not distinct between vertigo and dizziness arising from the inner ear and psychogenic vertigo and dizziness (2) or migraine-induced vertigo and dizziness, which can closely mimic Menière's disease.

Nor is there any pathophysiological explanation why betahistine influences, or might be supposed to influence, the course of Menière's disease, except for the fact that this disease, once it has been present for many years, usually becomes less severe over time as part of its natural course. Our current pathophysiological understanding of Menière's disease is that it is due to endolymphatic hydrops, which cannot be influenced by an antihistamine. DOI: 10.3238/arztebl.2008.747b


Priv. Doz. Dr. med. Gerhard Hesse
Dr. med. Helmut Schaaf
Tinnitus-Klinik und Ohr- und Hörinstitut Hessen
am Krankenhaus Bad Arolsen
Große Allee 50
34454 Bad Arolsen, Germany
drgerhardhesse@googlemail.com
Hschaaf@schoen-kliniken.de
1.
Eckhardt-Henn A, Hoffmann SO, Tettenborn B, Thomalske C, Hopf HC: Phobischer Schwankschwindel – Eine weitere Differenzierung psychogener Schwindelzustände erscheint erforderlich. Nervenarzt 1997; 68: 806–12. MEDLINE
2.
Schaaf H: M. Menière. 5. Auflage. Heidelberg: Springer 2007; 222.
3.
Strupp M, Huppert D, Frenzel C et al.: Long-term prophylactic treatment of attacks of vertigo in Menière's disease – comparison of a high with a low dosage of betahistine in an open trial. Acta Otolaryngol (In press).
1. Eckhardt-Henn A, Hoffmann SO, Tettenborn B, Thomalske C, Hopf HC: Phobischer Schwankschwindel – Eine weitere Differenzierung psychogener Schwindelzustände erscheint erforderlich. Nervenarzt 1997; 68: 806–12. MEDLINE
2. Schaaf H: M. Menière. 5. Auflage. Heidelberg: Springer 2007; 222.
3. Strupp M, Huppert D, Frenzel C et al.: Long-term prophylactic treatment of attacks of vertigo in Menière's disease – comparison of a high with a low dosage of betahistine in an open trial. Acta Otolaryngol (In press).