University of Erlangen-Nuremberg, Erlangen, Germany.
Section of Neuro-otology, Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland.
Acta Neurol Scand. 2022 Nov;146(5):429-439. doi: 10.1111/ane.13676. Epub 2022 Aug 27.
Vestibular neuritis is a common neuro-otological entity. Therapeutically, corticosteroids are advised, although the evidence is limited. The objective of this review is to update meta-analyses of clinical trials that address the question of whether patients with vestibular neuritis treated with corticosteroids show better recovery than control patients. The electronic databases Medline, Scopus and Cochrane were searched for clinical trials for the years 1970-2020 without language restriction. Data were extracted, and outcome parameters were subjected to conventional and cumulative meta-analysis using a commercially available software program (www.meta-analysis.com). Finally, 15 trials with 363 participants in the treatment and 489 in the control groups were identified and could be included. Eight studies were judged to be at high risk of bias. The odds ratio (OR) for good outcome in the acute phase was 3.1 (95% CI 1.2-7.8; p = .015) in favour of steroid treatment leading to the number needed to treat (NNT) = 6 (95% CI 4-23). The odds ratio (OR) for restoration of vestibular function in the follow-up was 2.4 (95% CI 1.3-4.4; p = .004) for the benefit of steroid treatment resulting in a NNT = 7 (95% CI 5-18). The results of the cumulative statistics did not differ. The risk of adverse effects was higher in patients treated with steroids with an OR of 10.9 (95% CI 1.3-93.8; p = .015) and an estimated number needed to harm (NNH) = 4 (95% CI 3-19). The advantage for corticosteroids remained when differentiating between patients who participated in randomized or non-randomized clinical trials. Steroid treatment in vestibular neuritis resulted in a statistically significant benefit compared to control therapies. However, broad heterogeneity of the studies, mostly low-grade quality of studies, high risk of bias and broad confidence intervals put the findings into perspective allowing only a careful judgement of some benefit of corticosteroids. The findings, however, support the call for an adequately powered and well-designed randomized controlled trial to re-evaluate the effectiveness of corticosteroids.
前庭神经炎是一种常见的神经耳科学实体。治疗上建议使用皮质类固醇，但证据有限。本综述的目的是更新关于临床试验的荟萃分析，以解决前庭神经炎患者使用皮质类固醇治疗是否比对照组患者恢复更好的问题。电子数据库 Medline、Scopus 和 Cochrane 检索了 1970 年至 2020 年的临床试验，无语言限制。提取数据，并使用商业软件（www.meta-analysis.com）对结果参数进行常规和累积荟萃分析。最后，确定了 15 项治疗组 363 例和对照组 489 例的试验，并将其纳入。八项研究被认为有高偏倚风险。在急性期，良好结局的优势比（OR）为 3.1（95%CI 1.2-7.8；p=0.015），有利于皮质类固醇治疗，导致需要治疗的人数（NNT）为 6（95%CI 4-23）。在随访时恢复前庭功能的优势比（OR）为 2.4（95%CI 1.3-4.4；p=0.004），有利于皮质类固醇治疗，导致 NNT 为 7（95%CI 5-18）。累积统计数据的结果没有差异。接受皮质类固醇治疗的患者发生不良反应的风险更高，OR 为 10.9（95%CI 1.3-93.8；p=0.015），估计需要伤害的人数（NNH）为 4（95%CI 3-19）。当区分随机或非随机临床试验的患者时，皮质类固醇的优势仍然存在。与对照组治疗相比，前庭神经炎患者使用皮质类固醇治疗有统计学意义的获益。然而，研究的广泛异质性，主要是研究的低质量，高偏倚风险和广泛的置信区间，使研究结果得到了正确的评价，只能谨慎判断皮质类固醇的一些益处。然而，这些发现支持呼吁进行一项充分有力和精心设计的随机对照试验，以重新评估皮质类固醇的有效性。
