Steroids for Acute Vestibular Neuronitis-the Earlier the Treatment, the Better the Outcome?

Julia Sjögren, Måns Magnusson, Fredrik Tjernström, Mikael Karlberg
Otology & Neurotology 2019, 40 (3): 372-374

OBJECTIVE: To present findings that suggest steroid treatment within 24 hours of onset of vestibular neuronitis results in better restitution of vestibular function than treatment between 25 and 72 hours.

PATIENTS: Thirty-three consecutive patients (17 men, 16 women, mean age 57 yr, range 17-85 yr) with acute vestibular neuronitis and treated with steroids within 72 hours after symptom onset. Patients were divided into two groups depending on if they were treated within the first 24 hours or not.

INTERVENTIONS: Oral prednisolone 50 mg/d for 5 days with tapering of doses for the next 5 days, or combined with initial intravenous betamethasone 8 mg the first 1 to 2 days if the patient was nauseous.

MAIN OUTCOME MEASURES: Proportion of patients with normal caloric test result (canal paresis value < 32%) at follow-up after 3 or 12 months.

RESULTS: All 9 patients (100%) treated within 24 hours from onset of vestibular neuronitis had normal caloric test results at follow-up after 3 months, as compared with 14 of 24 (58%) of the patients treated between 25 and 72 hours (p < 0,05, Fisher's exact test).

CONCLUSIONS: The timing of steroid treatment of vestibular neuronitis may be of importance for subsequent vestibular restitution, and hence, for both time to recovery and late symptoms according to the literature.

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Matt Crowson

Agree with authors that caloric does not correspond to symptoms. Would have been better to use vHIT (if available)


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