title: Betahistine as an add-on: The magic bullet for postoperative nausea, vomiting and dizziness after middle ear surgery?
abstract: OBJECTIVE
  Patients undergoing middle ear surgery experience variable degrees of postoperative nausea and vomiting (PONV) despite prophylaxis and treatment with ondansetron or other 5HT3 receptor antagonists. Furthermore vertigo or dizziness are not well controlled perioperatively. Role of betahistine was tested as an add-on to ondansetron in control of PONV and vertigo in middle ear surgery cases.
  
  
  METHODS
  We conducted a prospective, randomized, double-blind, placebo controlled study, enrolling one hundred patients undergoing middle ear surgery under local anesthesia into two groups consisting of fifty (n = 50) patients each. Group A patients were given betahistine 16 mg plus ondansetron 8 mg and placebo plus ondansetron 8 mg were given to group B or placebo group, orally 3 hours before starting operation. The incidence of nausea, vomiting, and dizziness was noted during the intraoperative and postoperative 24 hours period. Chi-square test, unpaired 't' test, and Fisher's exact tests were performed for statistical analysis using SPSS version 16 and Open Epi version 2.3.1 softwares.
  
  
  RESULTS
  Complete response was obtained in 90% patients in the betahistine group as compared to 66% in the placebo group. Vomiting in the intraoperative and postoperative period was noted in 4% and 8% cases, respectively, in the betahistine group as compared to 18% and 26%, respectively, in the placebo group. Overall, vertigo was 10% versus 32% in betahistine group and placebo group, respectively.
  
  
  CONCLUSIONS
  Betahistine as an add-on to ondansetron can significantly attenuate PONV and perioperative vertigo, following middle ear surgeries.
authors.affiliation: Department of Pharmacology, Christian Medical College, Ludhiana, Punjab, India.
authors.forename: Sandip
authors.initials: S
authors.lastname: Mukhopadhyay
authors.forename: Mausumi
authors.initials: M
authors.lastname: Niyogi
authors.forename: Ritam
authors.initials: R
authors.lastname: Ray
authors.forename: Basabdatta Samanta
authors.initials: BS
authors.lastname: Mukhopadhyay
authors.forename: Manotosh
authors.initials: M
authors.lastname: Dutta
authors.forename: Monoj
authors.initials: M
authors.lastname: Mukherjee
keywords: Betahistine; middle ear surgery; nausea; ondansetron; postoperative nausea and vomiting; vertigo; vomiting