Leong Kai-Jing, Lau Timothy, Stewart Vicky, Canetti Elisa F D
Faculty of Health Sciences and Medicine, Bond University, Robina, Australia.
Gold Coast University Hospital, Southport, Australia.
Otolaryngol Head Neck Surg. 2021 Aug;165(2):255-266. doi: 10.1177/0194599820982910. Epub 2021 Feb 2.
To determine whether steroids are effective in treating adults with acute vestibular neuritis.
PubMed, Embase, CINAHL, Cochrane CENTRAL, Web of Science, CAB Abstract, ICTRP, LILACS, PEDRO, ClinicalTrials.Gov, Google Scholar, NARIC, and OT Seeker.
A systematic review was undertaken for articles reporting subjective and/or objective outcomes of corticosteroids in adults with acute vestibular neuritis between December 2010 and October 2019. Reports of patient recovery from clinical vestibular outcomes at various time points and adverse effects from corticosteroids were of interest. Statistical analysis included qualitative and quantitative assessments. A limited meta-analysis of the data was performed through a random effects model.
Eight studies met the criteria, and 6 were included in the meta-analysis. No significant differences between the groups (corticosteroid vs placebo, corticosteroid vs vestibular exercise, or corticosteroid vs combination of vestibular exercise and corticosteroid) were reported in the proportion of patients with complete recovery at 1, 6, and 12 months. The corticosteroid group had significantly better caloric recover at 1 month (95% CI, -16.33 to -0.32); however, there was no significant difference to the overall effect between the groups across 12 months. Subjective recovery did not differ between the groups. Five of the 8 studies reported on adverse effects from corticosteroids.
There is insufficient evidence to support the use of corticosteroids in managing acute vestibular neuritis in adults. At present, corticosteroids appear to have short-term benefits in canal paresis but no long-term benefits in canal paresis and symptomatic recovery. Future studies should consider including a wider variety of clinical vestibular tests and frequent acute follow-ups to monitor the effects of corticosteroids.
确定类固醇是否对治疗成人急性前庭神经炎有效。
PubMed、Embase、CINAHL、Cochrane CENTRAL、Web of Science、CAB Abstract、ICTRP、LILACS、PEDRO、ClinicalTrials.Gov、谷歌学术、NARIC和OT Seeker。
对2010年12月至2019年10月期间报告成人急性前庭神经炎患者使用皮质类固醇主观和/或客观结果的文章进行系统综述。关注患者在不同时间点从临床前庭结果中恢复的报告以及皮质类固醇的不良反应。统计分析包括定性和定量评估。通过随机效应模型对数据进行了有限的荟萃分析。
八项研究符合标准，六项纳入荟萃分析。在1个月、6个月和12个月时完全康复的患者比例方面，各治疗组（皮质类固醇与安慰剂、皮质类固醇与前庭锻炼、或皮质类固醇与前庭锻炼和皮质类固醇联合治疗）之间未报告有显著差异。皮质类固醇组在1个月时冷热试验恢复情况明显更好（95%CI，-16.33至-0.32）；然而，在12个月期间，两组之间的总体效果没有显著差异。各治疗组之间主观恢复情况没有差异。八项研究中有五项报告了皮质类固醇的不良反应。
没有足够的证据支持在成人急性前庭神经炎管理中使用皮质类固醇。目前，皮质类固醇似乎在半规管轻瘫方面有短期益处，但在半规管轻瘫和症状恢复方面没有长期益处。未来的研究应考虑纳入更广泛的临床前庭测试，并进行频繁的急性随访以监测皮质类固醇的效果。
