Therapeutic Effect of Steroids on Vestibular Neuritis: Systematic Review and Meta-analysis

Kim, Gaeun; Seo, Jae‐Hyun; Lee, Seung-Jae; Lee, Dong-Hee

doi:10.22541/au.162613189.93277670/v1

Cited by 3 publications

(4 citation statements)

References 17 publications

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“…It is assumed that as a result of intercurrent factors, which impair the immune system, HSV-1 replicates and induces an inflammation and oedema and, thereby, secondary cell damage of the vestibular ganglion cells and axons in the bony canals, which may also explain the therapeutic effect of steroids in the very acute phase [77,149].…”

Section: Etiologymentioning

confidence: 99%

Acute unilateral vestibulopathy/vestibular neuritis: Diagnostic criteria

Strupp¹,

Bisdorff

Furman

et al. 2022

VES

103

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This paper describes the diagnostic criteria for Acute Unilateral Vestibulopathy (AUVP), synonymous for vestibular neuritis, as defined by the Committee for the Classification of Vestibular Disorders of the Bárány Society. AUVP manifests as an acute vestibular syndrome due to an acute unilateral loss of peripheral vestibular function without evidence for acute central or acute audiological symptoms or signs. This implies that the diagnosis of AUVP is based on the patient history, bedside examination, and, if necessary, laboratory evaluation. The leading symptom is an acute or rarely subacute onset of spinning or non-spinning vertigo with unsteadiness, nausea/vomiting and/or oscillopsia. A leading clinical sign is a spontaneous peripheral vestibular nystagmus, which is direction-fixed and enhanced by removal of visual fixation with a trajectory appropriate to the semicircular canal afferents involved (generally horizontal-torsional). The diagnostic criteria were classified by the committee for four categories: 1. “Acute Unilateral Vestibulopathy”, 2. “Acute Unilateral Vestibulopathy in Evolution”, 3. “Probable Acute Unilateral Vestibulopathy” and 4. “History of Acute Unilateral Vestibulopathy”. The specific diagnostic criteria for these are as follows: “Acute Unilateral Vestibulopathy”: A) Acute or subacute onset of sustained spinning or non-spinning vertigo (i.e., an acute vestibular syndrome) of moderate to severe intensity with symptoms lasting for at least 24 hours. B) Spontaneous peripheral vestibular nystagmus with a trajectory appropriate to the semicircular canal afferents involved, generally horizontal-torsional, direction-fixed, and enhanced by removal of visual fixation. C) Unambiguous evidence of reduced VOR function on the side opposite the direction of the fast phase of the spontaneous nystagmus. D) No evidence for acute central neurological, otological or audiological symptoms. E) No acute central neurological signs, namely no central ocular motor or central vestibular signs, in particular no pronounced skew deviation, no gaze-evoked nystagmus, and no acute audiologic or otological signs. F) Not better accounted for by another disease or disorder. “Acute Unilateral Vestibulopathy in Evolution”: A) Acute or subacute onset of sustained spinning or non-spinning vertigo with continuous symptoms for more than 3 hours, but not yet lasting for at least 24 h hours, when patient is seen; B) - F) as above. This category is useful for diagnostic reasons to differentiate from acute central vestibular syndromes, to initiate specific treatments, and for research to include patients in clinical studies. “Probable Acute Unilateral Vestibulopathy”: Identical to AUVP except that the unilateral VOR deficit is not clearly observed or documented. “History of acute unilateral vestibulopathy“: A) History of acute or subacute onset of vertigo lasting at least 24 hours and slowly decreasing in intensity. B) No history of simultaneous acute audiological or central neurological symptoms. C) Unambiguous evidence of unilaterally reduced VOR function. D) No history of simultaneous acute central neurological signs, namely no central ocular motor or central vestibular signs and no acute audiological or otological signs. E) Not better accounted for by another disease or disorder. This category allows a diagnosis in patients presenting with a unilateral peripheral vestibular deficit and a history of an acute vestibular syndrome who are examined well after the acute phase. It is important to note that since there is no definite test for AUVP. Therefore, its diagnosis requires the exclusion of central lesions as well as a variety of other peripheral vestibular disorders. Finally, this consensus paper will discuss other aspects of AUVP such as etiology, pathophysiology and laboratory examinations if they are directly relevant to the classification criteria.

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Section: Etiologymentioning

confidence: 99%

Acute unilateral vestibulopathy/vestibular neuritis: Diagnostic criteria

Strupp¹,

Bisdorff

Furman

et al. 2022

VES

103

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“…Associations of dizziness and tremors with imbalance may also explain observed associations with mobility/IADL disability. 20,21 The sensation of heavy limbs is often attributable to venous insufficiency or peripheral arterial disease. This incident symptom may represent the effect of SARS-CoV-2 on the cardiovascular system with alterations to microvascular perfusion on the peripheral limbs, thromboembolism, and endothelial injury.…”

Section: Discussionmentioning

confidence: 99%

“…While the high burden of physician diagnoses particularly among the most severely disabled group suggests that many are seeking clinical care, our data reinforces the need for those with early lingering symptoms to seek medical care that considers careful neurologic, vestibular, cardiovascular, and/or pulmonary evaluations. Additionally, there may be opportunities for the early administration of medications like corticosteroids 21 or consideration of anti-platelet regimens and physical therapy, although it remains unclear whether early intervention will alleviate long-term impacts.…”

Section: Discussionmentioning

confidence: 99%

Physical and mental health disability associated with long-COVID: Baseline results from a US nationwide cohort

Lau

Wentz

et al. 2022

Preprint

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Importance: Persistent symptoms after SARS-COV-2 infection, or long-COVID, may occur in anywhere from 10-55% of those who have had COVID-19, but the extent of impact on daily functioning and disability remains unquantified. Objective: To characterize physical and mental disability associated with long-COVID Design: Cross-sectional analysis of baseline data from a cohort study Setting: Online US nationwide survey Participants: Adults 18 years of age and older who live in the US who either report a history of COVID-19 illness (n=8,874) or report never having had COVID-19 (n=633) Main Outcome and Measures: Self-reported mobility disability (difficulty walking a quarter of a mile and/or up 10 stairs, instrumental activities of daily living [IADL] disability (difficulty doing light or heavy housework), and mental fatigue as measured by the Wood Mental Fatigue Inventory (WMFI). Results: Of 7,926 participants with long-COVID, the median age was 45 years, 84% were female, 89% self-reported white race, and 7.4% self-reported Hispanic/Latino ethnicity. Sixty-five percent of long-COVID participants were classified as having at least one disability, compared to 6% of those with resolved-COVID (n=948) and 14% of those with no-COVID (n=633). Of long-COVID participants, about 1% and 5% were classified as critically physically disabled or mentally fatigued, respectively. Age, prior comorbidity, increased BMI, female gender, hospitalization for COVID-19, non-white race, and multi-race were all associated with significantly higher disability burden. Dizziness at the time of infection (33% non-hospitalized, 39% hospitalized) was associated with all five disability components in both hospitalized and non-hospitalized groups. Heavy limbs, dyspnea, and tremors were associated with four of the five components of disability in the non-hospitalized group, and heavy limbs was associated with four of the five components in the hospitalized group. Vaccination was protective against development of disability. Conclusion and Relevance: We observed a high burden of physical and mental disability associated with long-COVID which has serious implications for individual and societal health that may be partially mitigated by vaccination. Longitudinal characterization and evaluation of COVID-19 patients is necessary to identify patterns of recovery and treatment options.

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“…Kortikosteroide scheinen damit einen Effekt in der akuten Phase zu haben. In einem systematischen Review mit Metaanalyse von 5 Studien mit 253 Patienten 53 wurde die Wirksamkeit sowohl in Bezug auf die vollständige Normalisierung als auch auf die Verbesserung der vestibulären Funktion – vor allem im Langzeitverlauf – gestützt. Um den Therapieeffekt von Steroiden zu belegen, ist mindestens eine weitere placebokontrollierte Studie notwendig.…”

Section: Leitsymptom: Akut Einsetzender Lang Dauernder Schwindelunclassified

Die sechs häufigsten peripherenvestibulären Syndrome

Strupp¹,

Zwergal²,

Goldschagg³

2023

Nervenheilkunde

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ZUSAMMENFASSUNGPeriphere vestibuläre Syndrome beruhen auf einer Funktionsstörung des Labyrinths und/oder des Nervus vestibulocochlearis. Phänomenologisch und pathophysiologisch lassen sich 3 Formen klinisch unterscheiden: 1. Rezidivierende Schwindelepisoden mit je nach Ursache unterschiedlicher Dauer, unterschiedlichen Begleitsymptomen und Auslösern. Die zugrunde liegenden Erkrankungen sind der Benigne periphere paroxysmale Lagerungsschwindel, Morbus Menière, Vestibularisparoxysmie und das Syndrom der dritten mobilen Fenster. 2. Das akute vestibuläre Syndrom, bedingt durch eine akute vestibuläre Tonusdifferenz mit dem Leitsymptom heftiger langdauernder Drehschwindel: die akute unilaterale Vestibulopathie/Neuritis vestibularis. 3. Persistierender Schwankschwindel und Gangunsicherheit bedingt durch ein bilaterales vestibuläres Defizit: die bilaterale Vestibulopathie. Für alle diese Erkrankungen liegen Diagnosekriterien der Bárány-Society vor, die gleichermaßen wichtig sind für die klinische Praxis und für wissenschaftliche Studien. Für die Behandlung peripherer vestibulärer Syndrome werden in Abhängigkeit von der Ursache 5 Therapieprinzipien eingesetzt: 1. Sorgfältige Aufklärung des Patienten über Art und Ursache der Beschwerden und die Therapieeffekte; dies ist auch wichtig für die Compliance des Patienten. 2. Physikalisch-medizinische Behandlung: A) Bogengangspezifische Befreiungsmanöver: für den posterioren Kanal das SémontPlus-Manöver, das dem Sémont- und Epley- Manöver überlegen ist; für den horizontalen Kanal das modifizierte Roll-Manöver und für den anterioren Bogengang das modifizierte Yacovino-Manöver. B) Balancetraining bei sensorischen Defiziten (hohe Evidenz). 3. Symptomatische oder kausale medikamentöse Behandlung. Hier mangelt es weiterhin an placebokontrollierten Pharmakotherapiestudien, sodass die Evidenzlage niedrig ist und ein hoher klinischer Forschungsbedarf besteht. 4. Operative Maßnahmen, z. B. bei dem Syndrom der dritten mobilen Fenster. 5. Bei funktionellem Schwindel psychotherapeutische Verfahren.

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Therapeutic Effect of Steroids on Vestibular Neuritis: Systematic Review and Meta-analysis

Cited by 3 publications

References 17 publications

Acute unilateral vestibulopathy/vestibular neuritis: Diagnostic criteria

Acute unilateral vestibulopathy/vestibular neuritis: Diagnostic criteria

Physical and mental health disability associated with long-COVID: Baseline results from a US nationwide cohort

Die sechs häufigsten peripherenvestibulären Syndrome

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