A 49 year old man complains of fullness in his left ear, recurrent vomiting and tinnitus. What is the most appropriate medicine?

The key is A. Buccal prochlorperazine. [Meniere’s disease Dilatation of the endolymphatic spaces of the membranous labyrinth causes vertigo for ~12h with prostration, nausea/vomiting, a feeling of fullness in the ear; uni- or bilateral tinnitus, sensorineural deafness (eg fluctuating). Attacks occur in clusters (<20/month). Cause: A mystery! Electrocochleography; endolymphatic space MRI. Prochlorperazine as BuccastemR 3mg/8h PO (1st-line if vomiting) or betahistine 16mg/8h PO or chlorthalidone may help. Ref: OHCS, 9th edition, page 554].