The role of steroids in short and long-term recovery from acute vestibular neuritis has been a subject of debate for several years. The authors reported findings of a prospective randomised trial in 60 adult patients. Inclusion criteria were acute vertigo within minutes to hours at examination, a positive unilateral horizontal head thrust, unilateral caloric paresis, normal audiogram and normal middle ear function. Patients with a previous vestibular disorder, aural, psychiatric and neurological diseases were excluded. Subjects were divided equally into three groups: a) vestibular rehabilitation – VR for six weeks, b) steroid group – 20mg methylprednisolone tapered over one week with gastric protection and c) combination group – VR and steroids. All subjects were assessed by history, clinical examination, caloric, cVEMPs and dizziness handicap inventory (DHI) at day four after onset and at one, three, six and 12 months. As previously reported in the literature, there was no correlation between degree of caloric paresis and DHI scores although there was a steady improvement in both over the study period. At baseline, cVEMP, caloric abnormalities and DHI scores were comparable in all groups. Any otolith dysfunction present at baseline had recovered by month six in all groups except for one subject in the VR group.
Statistically, there were no differences in DHI between groups at all follow-up points. The authors concluded that VR and steroids were equally effective. Neither steroids alone, nor combined with VR, were superior to VR alone. To avoid potential side-effects, steroids are best avoided in such patients, but early VR should be advocated.