In reply
We thank Prof Sampson for his comments. As he mentioned in his letter, for a long time no product was approved for peripheral vertigo by the FDA. The fact that there were no appropriate treatments for Meniere disease and that vertiginous patients benefited from a nonspecific or placebo effect of therapy was yet concluded by Torok1 in 1977. In the meantime the current knowledge of the pathogenesis and treatment of vertigo and especially of Meniere disease gained increasing data quality. Twenty years later Claes and van de Heyning2 discussed the vestibular sedative, antiemetic, vasoactive, and diuretic effects of a couple of substances that are used in the treatment of Meniere disease in their review of literature. Betahistine is described as significantly more effective than placebo in 2 of 3 double-blind, randomized clinical trials, with a more favorable effect than a diuretic or piperazine comparator.2,3