A patient with acute vertigo, ipsilateral hearing loss, and tinnitus has caloric testing showing canal paresis of 45% on the right. The most appropriate initial pharmacological treatment for the acute vertigo is:

• A Betahistine 16 mg TDS long-term
• B Prochlorperazine or diazepam for acute vestibular suppression (short-term) ✓
• C Intravenous methylprednisolone to restore vestibular function
• D Intratympanic gentamicin to ablate the affected labyrinth

Explanation

Acute vestibular neuritis (or labyrinthitis) with acute vertigo is best managed initially with vestibular suppressants such as prochlorperazine or benzodiazepines for short-term symptom relief during the acute phase. These should not be continued beyond 3–5 days as they impede central vestibular compensation. Betahistine is used for Meniere's disease for long-term prophylaxis. Intratympanic gentamicin is reserved for intractable Meniere's. Steroids may accelerate recovery of function but are not the primary symptomatic treatment.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.