Corticosteroids in the treatment of vestibular neuritis: a systematic review and meta-analysis.
OBJECTIVE
To systematically review and meta-analyze the results of all randomized controlled trials comparing corticosteroids with placebo for the treatment of patients with vestibular neuritis.


METHODS
An electronic search was performed in MEDLINE, EMBASE, Cochrane Library, and CENTRAL databases, and then extensive hand-searching was performed for the identification of relevant studies. No time and language limitations were applied.


METHODS
Prospective randomized controlled trials comparing corticosteroids with placebo for the treatment of patients with vestibular neuritis.


METHODS
Odds ratios (ORs), weighted mean differences (WMD), 95% confidence intervals (CIs), and tests for heterogeneity were reported.


RESULTS
Four studies were eventually identified and systematically reviewed. Meta-analysis was feasible for 3 studies. Regarding the recovery of clinical symptoms, the proportion of patients with clinical recovery at 1 month after the initiation of therapy did not differ significantly between the corticosteroids and placebo groups (OR, 1.45; 95% CI, 0.26-8.01; p = 0.67). The proportion of patients with caloric complete recovery was significantly different between the corticosteroids and placebo groups both at 1 (OR, 12.64; 95% CI, 2.6-61.52; p = 0.002; heterogeneity, p = 0.53; fixed effects model) and 12 months (OR, 3.35; 95% CI, 1.45-7.76; p = 0.005; heterogeneity, p = 0.03; random effects model) after the initiation of therapy. The caloric extent of canal paresis at 12 months after the initiation of therapy seemed to differ significantly between patients who received corticosteroids and those who received placebo (WMD, -12.15; 95% CI, -19.85 to -4.46; p < 0.05; heterogeneity, p < 0.05; random effects model).


CONCLUSIONS
The present systematic review and meta-analysis, based on the currently available evidence, suggests that corticosteroids improve only the caloric extent and recovery of canal paresis of patients with vestibular neuritis. At present, clinical recovery does not seem be better in patients receiving corticosteroids.
Goudakos
John K
JK
1st Department of Otorhinolaryngology-Head and Neck Surgery, ENT Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece. jgoudakos@gmail.com
Markou
Konstantinos D
KD
Franco-Vidal
Valérie
V
Vital
Victor
V
Tsaligopoulos
Miltiadis
M
Darrouzet
Vincent
V
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D002150:Caloric Tests; D003627:Data Interpretation, Statistical; D005500:Follow-Up Studies; D006801:Humans; D016017:Odds Ratio; D018579:Patient Selection; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D018401:Sample Size; D016896:Treatment Outcome; D020338:Vestibular Neuronitis / Q000188:drug therapy*
D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents