Comparison between mesoglycan and betahistine in the treatment of vertigo and dizziness in elderly patients

BACKGROUND: The cochlear and the vestibular anatomical structures are very sensitive systems to modification on blood perfusion pressure. However, the relationship between the systemic circulation and inner ear ischemia seems to be more complex than frequently considered. In clinical practice, many drugs have been used to improve dizziness of vascular origin and it seems that all drugs have similar effects. Betahistine and mesoglycan are the most frequently used drugs but their prescription is empirical, and it is not possible to differentiate how and when to prescribe one or the other; frequently the prescription of one or the other depends only on the personal experience of the physician and not on a precise clinical indication or a specific desired effect.METHODS: To clarify the different effects of the two drugs, in this paper we have evaluated clinical outcomes collected by 39 vestibology centers on 819 patients with dizziness, at the first visit and at 3 and 6 months, comparing three treatment groups: with betahistine or mesoglycan alone or with both drugs. Patients underwent evaluation of hearing threshold, videonystagmoscopy (VNS) for spontaneous, positional and vibration-induced nystagmus, Head Impulse Test (HIT), Head Shaking Test (HST), clinical diary and Dizziness Handicap Inventory (DHI).RESULTS: There were 425 women (56.0%), and the mean (standard deviation) age was 70.7 (22.9) years. Vertigo was reported by 30.7% of patients, dizziness by 36.7% and both vertigo and dizziness by 32.6%.CONCLUSIONS: Our paper demonstrates that the mesoglycan contribute to reactivate the neural connections, re-establishing the vestibular network better than the bethaistine that instead reduce the vestibular function improving the symptom, but is not useful towards the healing of the disease.