Systematic Review and Meta‐analysis: Effectiveness of Corticosteroids in Treating Adults With Acute Vestibular Neuritis

Abstract

Objectives To determine whether steroids are effective in treating adults with acute vestibular neuritis. Data Sources PubMed, Embase, CINAHL, Cochrane CENTRAL, Web of Science, CAB Abstract, ICTRP, LILACS, PEDRO, ClinicalTrials.Gov, Google Scholar, NARIC, and OT Seeker. Review Methods A systematic review was undertaken for articles reporting subjective and/or objective outcomes of corticosteroids in adults with acute vestibular neuritis between December 2010 and October 2019. Reports of patient recovery from clinical vestibular outcomes at various time points and adverse effects from corticosteroids were of interest. Statistical analysis included qualitative and quantitative assessments. A limited meta-analysis of the data was performed through a random effects model. Results Eight studies met the criteria, and 6 were included in the meta-analysis. No significant differences between the groups (corticosteroid vs placebo, corticosteroid vs vestibular exercise, or corticosteroid vs combination of vestibular exercise and corticosteroid) were reported in the proportion of patients with complete recovery at 1, 6, and 12 months. The corticosteroid group had significantly better caloric recover at 1 month (95% CI, –16.33 to –0.32); however, there was no significant difference to the overall effect between the groups across 12 months. Subjective recovery did not differ between the groups. Five of the 8 studies reported on adverse effects from corticosteroids. Conclusion There is insufficient evidence to support the use of corticosteroids in managing acute vestibular neuritis in adults. At present, corticosteroids appear to have short-term benefits in canal paresis but no long-term benefits in canal paresis and symptomatic recovery. Future studies should consider including a wider variety of clinical vestibular tests and frequent acute follow-ups to monitor the effects of corticosteroids.

Acute Unilateral Peripheral Vestibulopathy After COVID-19 Vaccination: Initial Experience in a Tertiary Neurotology Center

“…In accordance with guidelines for other inactivated vaccines, it is recommended to wait for at least 2 weeks after vaccination before a highdose course of systemic steroids is started [Soy et al (76) and personal information: Dr. Nadia Eberhard-Kuhn, Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich]. As there is currently no high-quality evidence for the efficacy of systemic corticosteroids in AUPVP (77,78), the potential risks and benefits of starting a treatment should be balanced for each single patient. Consulting an immunologist or infectious disease specialist is useful in this context.…”

Current Insights into Treating Vertigo in Older Adults

“…Both viral and vascular factors may contribute to AUV presentations. On the basis of a viral origin of AUV, a short course of corticosteroids may be indicated [37], although a very recent systematic review and meta-analysis concluded that there is insufficient evidence to support their use in AUV [38]. On the contrary, a retrospective study demonstrated that patients receiving a steroid treatment (methylprednisolone 1 mg/kg for 5 days with an additional 5 days of 0.5 mg/ kg) showed better results in terms of vestibular recovery and symptomatic relief/improvement compared to patients receiving non-glucocorticoid treatment [39].…”

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

“…12 The analysis by Solis et al ( 2018) included four studies concluding that there is insufficient evidence to make a general recommendation for corticosteroid treatment. 13,19,22,24,27 Following our systematic analysis, the review by Leong et al 14 (2021) has been published. They included eight studies concluding that there is insufficient evidence to support the use of corticosteroids.…”

“…They included eight studies concluding that there is insufficient evidence to support the use of corticosteroids. 14,[25][26][27][28][29][30][31]33 They focused on caloric recovery at various time points, results of the DHI and length of hospital stay. 14 The aim of our meta-analysis was to include all available studies, the older 17,18 and the newer ones.…”

“…The odds ratio (OR) for good outcome in the acute phase was 3.1 (95% CI 1.2-7.8; p = .015) in favour of steroid treatment leading to the number needed to treat (NNT) = 6 (95% CI [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23]. The odds ratio (OR) for restoration of vestibular function in the follow-up was 2.4 (95% CI 1.3-4.4; p = .004) for the benefit of steroid treatment resulting in a NNT = 7 (95% CI [5][6][7][8][9][10][11][12][13][14][15][16][17][18]. The results of the cumulative statistics did not differ.…”