Betahistine (Serc) is a popular medicine that is prescribed to treat a variety of complaints. The main indication for taking Betahistine is to treat patients with Ménière’s disease, however many patients take Betahistine to relieve other symptoms, such as vertigo, dizziness, and tinnitus.
Good evidence to support the use of Betahistine for the treatment of Ménière’s disease is severely lacking despite its common use. About five years ago a scientific study was performed in China to evaluate the potential benefits of Betahistine for tinnitus patients. The results of this study demonstrated a reduction in the loudness of tinnitus when using special hearing tests to assess tinnitus loudness, but when questionnaires were used to assess whether the subjects felt that their tinnitus was quieter, or whether the impact of tinnitus on their life was reduced, no improvements could be satisfactorily demonstrated. The results of this study, to some degree, are interesting, however this type of study has not been replicated in either China, or anywhere else in the rest of the world. Only a summary of this study has been reproduced in English, so I have written to the authors for clarification of the methods used and some more details regarding the study findings, but unfortunately I am still waiting for a reply.
Despite reservations regarding the benefits of taking Betahistine, it remains a popular medicine prescribed by general practitioners with over 100,000 prescriptions being filled every month in England. A recent study has reported that nearly 10% of general practitioners prescribe Betahistine for tinnitus. However, amongst experts in the field of tinnitus, other methods are used to treat tinnitus, as there is more confidence in methods that are backed up with more substantial research.
For patients with Ménière’s disease, I explain to them that although there is no evidence that Betahistine works, it doesn’t mean that it doesn’t work, but rather that no well designed scientific study has demonstrated a beneficial effect when comparing Betahistine with a suitable placebo.
There is so much we still fail to understand about both Ménière’s disease and tinnitus. Betahistine is thought to work by improving blood flow to certain areas within the inner ear. However, we do not fully understand how Betahistine actually interacts within the inner ear to reduce the symptoms for which it is prescribed. Many people feel that the holy grail of tinnitus research is to develop a single drug to ‘cure’ tinnitus, however to date no such drug has been scientifically proven to fulfill this role.
Unfortunately, Betahistine is not the only drug available in England that is purported to help patients with tinnitus despite a lack of indisputable evidence to support its use. A whole host of drugs, herbs, vitamins and complementary substances are available via both reputable practitioners as well as questionable sources over the internet. Our knowledge about the mechanisms at play in tinnitus is continuing to improve, but current research would indicate that the key to improving the lives of many tinnitus sufferers may not lie solely in developing a drug treatment.
Many other forms of treatment are being studied for the treatment of tinnitus, including psychological treatments and the use of a variety of medical devices. Tinnitus is a complex disorder, to provide us with the best opportunity to improve the lives of tinnitus sufferers all avenues of tinnitus research need to be explored rather than concentrating our efforts on developing a single miracle cure.
Reference:
Phillips JS & Prinsley PR, Prescribing practices for Betahistine British Journal of Clinical Pharmacology, 65:4, February 2008
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