Betahistine has been prescribed to patients with MD for many years in Europe, Canada, and most other countries, (excluding the US). Recent reviews suggest that it is both effective and safe in adequate doubleblind, controlled studies. As also suggested by this retrospective study, its efficacy is limited to control of vertigo spells. Disappointingly, no therapeutic effect of betahistine on tinnitus and hearing loss due to MD emerges from either the international medical literature or the results of this study. Nonetheless, this retrospective study confirms recent clinical experience about its efficacy in reduction of postural symptoms due to the asymmetry of vestibulo-spinal reflexes. Nimodipine exerts not only an additional effect on the control of vertigo attacks and a further reduction of vestibulo-spinal impairment, but also a specific and positive action on tinnitus annoyance and sensorineural hearing loss. Therefore, the fixed combination of betahistine and nimodipine seems to provide patients with MD the typical advantage of a multicomponent therapy, namely a better control extended to the majority of symptoms. Further investigations with adequate study design on the off-label prescription of nimodipine alone in inner ear dysfunctions in humans are recommended. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3552538/