No Evidence to Support Use of Corticosteroids in Treatment of Adults with Acute Vestibular Neuritis

Are steroids effective in treating adults with acute vestibular neuritis (VN)?

BOTTOM LINE

There is insufficient evidence to support the use of corticosteroids in managing acute VN in adults.

BACKGROUND: Affecting approximately 3.5 per 100,000 population, VN is the second-most common cause of peripheral vertigo. Symptoms, such as severe rotatory vertigo, nausea, spontaneous horizontal/torsional nystagmus, gait deviation, and tendency to fall, can be masked by pathologies such as strokes. Treatment for acute VN includes vestibular exercises, pharmacotherapy, or both.

COMMENT: This systematic review evaluates the use of corticosteroids for treatment of acute vestibular neuritis. A clinical practice guideline exists for treatment of sudden sensorineural hearing loss, but there’s no similar guideline for the treatment of acute vestibular neuritis. This article addresses this gap in knowledge by summarizing relevant studies and finds that there is insufficient evidence to support the use of corticosteroids in managing acute vestibular neuritis in adults. —Cristina Cabrera-Muffly, MD

STUDY DESIGN: Systematic review and meta-analysis.

SETTING: Faculty of Health Sciences and Medicine, Bond University, Robina, Australia.

SYNOPSIS: For their review, researchers identified eight eligible studies reporting outcomes of corticosteroid treatment in adults with acute VN between December 2010 and December 2016. The review included a comparison based on dosage, timing, or intervention (placebo, no treatment, any active intervention, and/or active capacitor). Eligible studies assessed vestibular recovery through subjective or objective outcomes. Primary review outcomes were the proportion of patients who recover from VN and the degree of recovery of peripheral vestibular function. Researchers found no significant differences between the groups (corticosteroid versus placebo, corticosteroid versus vestibular exercise, or corticosteroid versus combination of vestibular exercise and corticosteroid) in the proportion of patients with complete recovery at one, six, and 12 months. The corticosteroid group had significantly better caloric recovery at one month, but there was no significant difference to the overall effect between the groups across 12 months. Subjective recovery did not differ between groups. Authors concluded that although corticosteroids appear to have short-term benefits in canal paresis, there’s no evidence of long-term benefits in canal paresis or symptomatic recovery. Limitations included the low methodological quality and small sample sizes in six of the studies.

CITATION: Leong KJ, Lau T, Stewart V, et al. Systematic review and meta-analysis: effectiveness of corticosteroids in treating adults with acute vestibular neuritis. Otolaryngol Head Neck Surg. 2021;165:255-266.