Adrian James, Martin J Burton

Menière's disease is characterised by attacks of hearing loss, tinnitus and disabling vertigo. Betahistine is used by many people to reduce the frequency and severity of these attacks but there is conflicting evidence relating to its effects. The objective of this review was to assess the effects of betahistine in people with Menière's disease. We searched the Cochrane Controlled Trials Register (The Cochrane Library issue 4,1999), MEDLINE (January 1966 to December 1999), EMBASE (January 1985 to December 1999) and Index Medicus (1962 to 1966). We checked reference lists of articles and contacted pharmaceutical companies for further studies. Randomised controlled studies of betahistine versus placebo in Menière's disease. Two reviewers independently assessed trial quality and extracted data. Study authors were contacted for further information. Six trials involving 162 patients were included. No trial met the highest quality standard set by the review because of inadequate diagnostic criteria or methods, and none assessed the effect of betahistine on vertigo adequately. Most trials suggested a reduction of vertigo with betahistine and some suggested a reduction in tinnitus but all these effects may have been caused by bias in the methods. One trial with good methods showed no effect of betahistine on tinnitus compared with placebo in 35 patients. None of the trials showed any effect of betahistine on hearing loss. No adverse effects were found with betahistine. There is insufficient evidence to say whether betahistine has any effect on Menière's disease.