A Cochrane review «Fishman JM, Burgess C, Waddell A. Corticosteroids for the treatment of idiopathic acute vestibular dysfunction (vestibular neuritis). Cochrane Database Syst Rev 2011;(5):CD008607. »1 «Corticosteroids for the treatment of idiopathic acute vestibular dysfunction (vestibular neuritis)»1 included 4 RCTs with a total of 149 patients with acute vestibular neuritis. The trials compared the effectiveness of oral corticosteroids against placebo. The diagnostic criteria for acute vestibular neuritis differed; all trials also used different treatment regimens. Although there was an overall significant effect of corticosteroids on complete caloric recovery at one month (RR of 2.81; 95% CI 1.32 to 6.00), no significant effect was seen on complete caloric recovery at 12 months (RR 1.58; 95% CI 0.45 to 5.62), or on the extent of caloric recovery at either one month (mean difference (MD) 9.60%; 95% CI -20.66 to 39.86) or 12 months (MD 6.83%; 95% CI -27.69 to 41.36). In addition, there was no significant difference between corticosteroids and placebo in the symptomatic recovery of vestibular function following acute vestibular neuritis with respect to vertigo at 24 hours (RR 0.39; 95% CI 0.04 to 3.57, P = 0.40) and use of the Dizziness Handicap Inventory score at one, three, six and 12 months. The data on symptom-based and health-related quality of life outcome measures, which would provide more patients-related information, was scarce.
Comment: The quality of evidence is downgraded by inconsistency (heterogeneity in patients, treaments and outcomes), indirectness (differences in outcomes) and imprecise results (few patients and wide confidence intervals).