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Corticosteroids and Vestibular Exercises in Vestibular Neuritis

Posted by Kerrie Denner

The purpose of this clinical trial is to compare the use of vestibular exercises vs corticosteroid therapy in the recovery of patients with acute vestibular neuritis.

Single-blind Randomized Clinical Trial

John K. Goudakos, MD, MSc1; Konstantinos D. Markou, MD, PhD1; George Psillas, MD, PhD1; Victor Vital, MD, PhD1; Miltiadis Tsaligopoulos, MD, PhD1

Abstract

Importance  The management of patients with unilateral acute vestibular neuritis (VN) has not been established to date.

Objective  To compare the use of vestibular exercises vs corticosteroid therapy in the recovery of patients with acute VN.

Design, Setting, and Participants  Prospective, single-blind, randomized clinical trial at a primary referral center. Among all patients with acute vertigo, those having VN were eligible for inclusion in the study.

Interventions  Forty patients with acute VN were randomly assigned to perform vestibular exercises or to receive corticosteroid therapy. After a baseline examination, follow-up evaluations were performed at 1, 6, and 12 months.

Main Outcomes and Measures  Efficacy outcomes included clinical, canal, and otolith recovery. Scores on the European Evaluation of Vertigo Scale and the Dizziness Handicap Inventory were used for the evaluation of clinical recovery. Findings of caloric irrigation and vestibular evoked myogenic potentials indicated canal and otolith improvement, respectively.

Results  Comparing the 2 treatment groups, no statistically significant differences were found in clinical, canal, or otolith recovery. At the 6-month examination, the number of patients with complete disease resolution in the corticosteroids group was significantly higher than that in the vestibular exercises group. However, at the end of the follow-up period, 45% (9 of 20) of patients in the vestibular exercises group and 50% (10 of 20) of patients in the corticosteroids group had complete disease resolution (P > .05).

Conclusions and Relevance  Treating patients who have acute VN with vestibular exercises seems equivalently effective as treating them with corticosteroid therapy in clinical, caloric, and otolith recovery. Corticosteroid therapy seems to enhance earlier complete acute VN resolution, with no added benefit in the long-term prognosis.

Trial Registration  clinicaltrials.gov Identifier: NCT01231009

Source: JAMA Otolaryngology

url: http://archotol.jamanetwork.com/article.aspx?articleID=1835393&utm_source=Silverchair%20Information%20Systems&utm_medium=email&utm_campaign=ArchivesofOtolaryngology%3AOnlineFirst03%2F06%2F2014

Accessed 3/11/2014

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