Hydropic Ear Disease: Menière and friends

Diagnosis and classification of Menière’s disease (MD) have been difficult in the past. Since 1995, the globally accepted standard was defined by the AAO-HNS criteria for MD. The certain diagnosis was, however, only possible post-mortem, and as a consequence subjective symptom-based classifications have been used. Today we can overlook a whole decade of experience with clinical in-vivo diagnosis of endolymphatic hydrops on MRI, which enables a certain diagnosis. This led to the development of the novel concept of Hydropic Ear Disease, which reunites the cochlear, vestibular and cochleovestibular variants of MD and the primary as well as the secondary forms under one roof. With today’s diagnostic possibilities - not only inner ear imaging - it is time to move from a subjective symptom based classification towards a classification including objective diagnostic tests. The concept of Hydropic Ear Disease is independent from MR imaging and provides a suitable framework to be used in high-tech as well as low-tech settings.

Since its market introduction about 50 years ago, Betahistine has been widely used, despite a lack of evidence for efficacy which has led to a withdrawal of the license in the United States. The evidence emanating from various types of studies, including randomized controlled trials, is reviewed and critically analyzed. In 2016, the milestone placebo-controlled RCT of high-dose Betahistine in 221 patients (BEMED trial) has clearly identified Betahistine as a placebo, and its use is therefore not recommended. The highest level of positive evidence currently favors ablative vestibular therapy such as Gentamicine. New function-preserving medical treatments are currently being developed such as intratympanic sustained release corticosteroid therapy.