Betahistine is ineffective, patients urgently need better alternatives The publication of a very well constructed randomised controlled trial1 of betahistine (Serc) for Meniere’s disease underlines the lack of evidence for the efficacy of this drug at both low and high doses. What does this mean for current and future users? Meniere’s disease is one of the most puzzling inner ear syndromes. It is typically described with a collection of symptoms, which might not occur all at once in the same person. These include tinnitus, vertigo, sensorineural hearing loss, and aural fullness. Currently, we don’t have a precise idea of aetiology, despite many efforts to indentify underlying causes. Common sensory or pathophysiological elements have been observed—such as endolymphatic hydrops (a distension of the membranous labyrinth2)—and some aetiological theories have been proposed, none of which has been able to inform a one-for-all treatment. The general approach to treatment is influenced by the severity of the symptoms, by the professional and personal views of the treating specialist, and by …