By Marcello Cherchi, MD PhD
For patients
Beta blockers are drugs that are mostly used for certain heart diseases. Sometimes they can be used for helping people with disequilibrium related to migraine.
For clinicians
Overview
Beta adrenergic receptor antagonists, usually referred to simply as “beta blockers,” were developed in the late 1950’s, originally for a variety of cardiac applications (Frishman 2008). Over time these drugs have earned other FDA-approved indications, and have also come to be used off-label for a variety of non-cardiac conditions.
Introduction
Beta blockers antagonize beta adrenergic receptors, reducing the ability of catecholamines to bind to these receptors. Beta blockers are often classified according to their degree of selectivity; the term “selective” refers to those compound that preferentially block beta‑1 adrenergic receptors, while “nonselective” compounds block both beta‑1 and beta‑2 receptors to some degree. The various beta blockers also differ from each other in parameters such as binding affinity, half-lives, bioavailability, etc.
Relevance in otoneurology
The main relevance of beta blockers in otoneurology is probably in the prophylactic management of migraine associated vertigo, similar to other migraines.
Less common disorders encountered in otoneurology include superior oblique myokymia, which is sometimes treated with beta blocker eye drops such as timolol (Borgman 2014; Sathyan and Antony 2017; Smith and Cornblath 2014).
Cautions and contraindications
Beta blockers are relatively contraindicated in patients with a history of asthma because of the potential for beta‑2 receptor antagonism, which can cause bronchoconstriction.
References
Borgman CJ (2014) Topical timolol in the treatment of monocular oscillopsia secondary to superior oblique myokymia: a review. J Optom 7: 68-74. doi: 10.1016/j.optom.2013.06.004
Frishman WH (2008) beta-Adrenergic blockers: a 50-year historical perspective. Am J Ther 15: 565-76. doi: 10.1097/MJT.0b013e318188bdca
Sathyan S, Antony RC (2017) Superior Oblique Myokymia: Some Novel Observations. Middle East Afr J Ophthalmol 24: 162-164. doi: 10.4103/meajo.MEAJO_78_17
Smith TA, Cornblath WT (2014) Alternating superior and inferior oblique myokymia. JAMA Ophthalmol 132: 898-9. doi: 10.1001/jamaophthalmol.2014.366
