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Vestibular neuronitis - Management
Basis for recommendation
Choice of drug treatment
- The recommendation that symptomatic treatment can be useful in the short term is based on expert opinion in review articles and the opinion of CKS expert reviewers [Nadol, 1995; Hanley et al, 2001; Macleod and McAuley, 2008].
- CKS found no good-quality evidence of benefit for the different symptomatic treatment options. However, the recommended drugs are all licensed for use in people with nausea, vomiting, and vertigo [ABPI Medicines Compendium, 2010a; ABPI Medicines Compendium, 2010c; ABPI Medicines Compendium, 2010d; ABPI Medicines Compendium, 2010e; ABPI Medicines Compendium, 2010f].
Duration of drug treatment
- Expert opinion from review articles suggests that symptomatic drug treatment should only be used in the short term, because prolonged use may delay central vestibular compensation [Nadol, 1995; Hanley et al, 2001; Macleod and McAuley, 2008]. The opinion of CKS expert reviewers was consistent with this.
Corticosteroids
- Some experts consider that the use of corticosteroids in people with vestibular neuronitis may improve vestibular function in the long term; however, this is uncertain, and high doses are used [Kuo et al, 2008a; Seemungal and Bronstein, 2008].
- Evidence from a systematic review and meta-analysis suggests that, compared with placebo, corticosteroids for vestibular neuronitis cause improvement on caloric testing, but do not affect clinical symptoms [Goudakos et al, 2010].
Antiviral drugs
- Evidence from a prospective study with some methodological limitations found that methylprednisolone improved the vestibular recovery of people with vestibular neuronitis, but valaciclovir did not [Strupp et al, 2004].
Benzodiazepines
- Benzodiazepines are not recommended because although some experts advocate their use, CKS found no evidence to support this, and they are not licensed for this purpose [BNF 60, 2010].
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