Corticosteroids in patients with vestibular neuritis: An updated meta‐analysis

Bogdanova, Anna; Dlugaiczyk, Julia; Heckmann, Josef G.; Schwab, Stefan

doi:10.1111/ane.13676

Cited by 5 publications

(3 citation statements)

References 36 publications

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“…Specifically, only 46% of PCPs indicated that they often or even always prescribe steroids for this condition. This probably reflects the ongoing discussion on the value of steroid treatment in acute unilateral vestibulopathy with diverging recommendations ( 28 , 29 ). To what extent accompanying diseases (such as diabetes or psychiatric co-morbidities) have biased this decision has not been addressed in this questionnaire.…”

Section: Discussionmentioning

confidence: 98%

What is the current status of primary care in the diagnosis and treatment of patients with vertigo and dizziness in Switzerland? A national survey

Zwergal,

Mantokoudis,

Heg

et al. 2023

Front. Neurol.

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BackgroundVertigo and dizziness are among the most frequent presenting symptoms in the primary care physicians' (PCPs) office. With patients facing difficulties in describing their complaints and clinical findings often being subtle and transient, the diagnostic workup of the dizzy patient remains challenging. We aimed to gain more insights into the current state of practice in order to identify the limitations and needs of the PCPs and define strategies to continuously improve their knowledge in the care of the dizzy patient.Materials and methodsBoard-certified PCPs working in Switzerland were invited to participate in an online survey. A descriptive statistical analysis was performed, and prospectively defined hypotheses were assessed using regression analyses.ResultsA vast majority of participating PCPs (n = 152) were familiar with the key questions when taking the dizzy patient's history and with performing provocation/repositioning maneuvers when posterior-canal benign paroxysmal positional vertigo (BPPV) was suspected (91%). In contrast, strong agreement that performing the alternating cover test (21%), looking for a spontaneous nystagmus with fixation removed (42%), and performing the head-impulse test (47%) were important was considerably lower, and only 19% of PCPs were familiar with lateral-canal BPPV treatment. No specific diagnosis could be reached in substantial fractions of patients with acute (35% [25; 50%], median [inter-quartile range]) and episodic/chronic (50% [40; 65.8%]) dizziness/vertigo. Referral to specialists was higher in patients with episodic/chronic dizziness than in acutely dizzy patients (50% [20.3; 75] vs. 30% [20; 50]), with younger PCPs (aged 30–40 years) demonstrating significantly increased odds of referral to specialists (odds ratio = 2.20 [1.01–4.81], p = 0.048).ConclusionThe assessment of dizzy patients takes longer than that of average patients in most primary care practices. Many dizzy patients remain undiagnosed even after a thorough examination, highlighting the challenges faced by PCPs and potentially leading to frequent referrals to specialists. To address this, it is crucial to promote state-of-the-art neuro-otological examination and treatment techniques that are currently neglected by most PCPs, such as “HINTS” and lateral-canal BPPV treatment. This can help reduce referral rates allowing more targeted treatment and referrals.

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Section: Discussionmentioning

confidence: 98%

What is the current status of primary care in the diagnosis and treatment of patients with vertigo and dizziness in Switzerland? A national survey

Zwergal,

Mantokoudis,

Heg

et al. 2023

Front. Neurol.

View full text Add to dashboard Cite

show abstract

“…Betahistine, ondansetron, cinnarizine, flunarizine, dimenhydrinate, and diazepam are among the most widely studied vestibular supressants and should be preferred. Corticosteroids resulted in a statistically significant improvement in vestibular neuritis [ 113 ], so that the authors recommend their routine use in AUV. Despite the multitude of therapeutic options, there is a lack for larger, higher quality studies regarding the pharmacological treatment of AUV.…”

Section: Discussionmentioning

confidence: 99%

Pharmacological Treatment of Acute Unilateral Vestibulopathy: A Review

Sousa,

Alves,

Pinto

et al. 2024

J Audiol Otol

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There have been few investigations on the epidemiology, etiology, and medical management of acute unilateral vestibulopathy (AUV). Short-term pharmaceutical resolutions include vestibular symptomatic suppressants, anti-emetics, and some cause-based therapies. Anticholinergics, phenothiazines, antihistamines, antidopaminergics, benzodiazepines, and calcium channel antagonists are examples of vestibular suppressants. Some of these medications may show their effects through multiple mechanisms. In contrast, N-acetyl-L-leucine, Ginkgo biloba, and betahistine improve central vestibular compensation. Currently, AUV pathophysiology is poorly understood. Diverse hypotheses have previously been identified which have brought about some causal treatments presently used. According to some publications, acute administration of anti-inflammatory medications may have a deleterious impact on both post-lesional functional recovery and endogenous adaptive plasticity processes. Thus, some authors do not recommend the use of corticosteroids in AUV. Antivirals are even more contentious in the context of AUV treatment. Although vascular theories have been presented, no verified investigations employing anti-clotting or vasodilator medications have been conducted. There are no standardized treatment protocols for AUV to date, and the pharmacological treatment of AUV is still questionable. This review addresses the most current developments and controversies in AUV medical treatment.

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“…As stated in numerous publications, there is still a lack of evidence that the use of glucocorticoids is effective in improving long-term clinical outcomes. 15,16,[33][34][35][36] This is the same in vestibular rehabilitation. 33,35,36 Most of the earlier literature confirmed that there is no clear linear relationship between either DHI values or ΔDHI and UW, gain or asymmetry ratio within 1-3 months after onset in VN patients, and they do not seem to reflect patientspecific subjective vertigo symptoms at a given moment in time.…”

mentioning

confidence: 85%

Objective Neurological Testing Methods Used to Follow Up Vestibular Neuritis Depending on Different Factors

Li,

Miao,

Zhang

et al. 2023

IJGM

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Purpose We analyze the impact of different factors on clinical performance and prognosis in vestibular neuritis (VN) and explore indicators that could accurately reflect changes in patients’ symptoms at different stages. Methods We observed patients with VN during the acute and recovery phases. Clinical symptoms, vertigo-related scales, neurological examination, vestibular function tests (caloric test, video head impulse test (vHIT), vestibular evoked myogenic potential (VEMP)), and the history of disease (underlying diseases, glucocorticoid therapy) were recorded at onset and at 4 and 12 weeks after onset in VN patients. Multiple linear regression analysis was used to identify vestibular function tests that had a linear regression relationship with the subjective quantitative results. Results At 4 weeks after onset, the group without underlying disease had better improvement in EEV, gain, and UW than the group with underlying disease (P < 0.05). There was a significant difference in the change in DHI, EEV, gain of the affected horizontal semicircular canal in the vHIT and unilateral weakness (UW) between the glucocorticoid treatment group and the no glucocorticoid treatment group (P < 0.05), and glucocorticoid treatment group was better. The change value in the gain of horizontal canals in the vHIT was mainly positively and linearly correlated with the EEV scores (P<0.001). Possible dynamic correlation between vHIT results and vestibular symptoms. Conclusion The absence of underlying disease and the receipt of glucocorticoid therapy significantly contributed to the improvement of objective vestibular function tests in the short term, while the improvement of subjective vertigo may correlate with the different objective measures and questionnaire. We believe that the improvement of the affected horizontal semicircular canal gain value in the vHIT can be used as a reference indicator of the degree of improvement of vestibular symptoms with superior vestibular neuritis.

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Corticosteroids in patients with vestibular neuritis: An updated meta‐analysis

Cited by 5 publications

References 36 publications

What is the current status of primary care in the diagnosis and treatment of patients with vertigo and dizziness in Switzerland? A national survey

What is the current status of primary care in the diagnosis and treatment of patients with vertigo and dizziness in Switzerland? A national survey

Pharmacological Treatment of Acute Unilateral Vestibulopathy: A Review

Objective Neurological Testing Methods Used to Follow Up Vestibular Neuritis Depending on Different Factors

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