Vestibular neuritis (VN) is the third most common cause of peripheral vertigo. VN has been postulated to have viral aetiology and historically it was treated with steroids, until 2011 when a Cochrane review demonstrated lack of robust evidence behind this practice. Kim et al, in their recent meta-analysis, are revisiting the question about the use of steroids in the management of VM and are undertaking a systematic review of all literature over 50 years, including the new studies of the last 10 years. The authors conducted the current review following the PRISMA and Cochrane Handbook for Systematic reviews principles, including the PubMed, EMBASE and Cochrane Library databases. Inclusion criteria included randomised control trials consisting of VN patients with at least one group being treated with steroid therapy, while all non-randomised studies were excluded, as well as those lacking original data or not written in English. From an initial population of 276 articles, five were analysed, demonstrating a significant therapeutic effect of steroids on VN recovery in long-term follow-up. When VN recovery was assessed by complete caloric recovery or canal paresis resolution, corticosteroids demonstrated a significant therapeutic effect. Interestingly, a negative impact of steroid treatment on VN recovery was demonstrated from the post-medication dizziness handicap inventory score. Overall, when comparing the use of corticosteroids to non-steroid therapies, there was a statistically significant, albeit small, effect in favour of steroidal treatment. This article postulates that the effect of corticosteroids is not as negligible as the latest Cochrane review previously suggested. However, the significance of dizziness handicap and its comparison to caloric tests needs to be better clarified before we define the role of steroids in VN management.
Treatment options for vestibular neuritis: systematic review and meta-analysis
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