Evidence-based treatment of vestibular neuritis is a topic that has garnered significant interest due to the variability in treatment approaches and the need for more robust evidence. The traditional treatment methods outlined in current otorhinolaryngology textbooks emphasize early absolute bed rest, avoiding sound and light stimulation, and the use of anti-vertigo drugs. These treatments are predominantly passive and symptomatic, lacking sufficient evidence-based medicine options.
Given this situation, we have thoroughly reviewed relevant literature to propose an evidence-based model for treating vestibular neuritis. Observational studies indicate that caloric tests measuring peripheral vestibular function show glucocorticoid steroid therapy significantly promotes recovery in patients with vestibular neuritis compared to placebo groups. Literature also highlights that glucocorticoids can improve central compensation in these patients, even when peripheral vestibular function isn't fully restored.
The pathological damage in vestibular neuritis may resemble Bell's palsy, likely due to viral infections causing swelling and mechanical compression of the vestibular nerve within the temporal bone, forming a vicious cycle. Glucocorticoid hormones might treat vestibular neuritis through their anti-inflammatory properties by reducing swelling in the vestibular nerve and improving peripheral vestibular function.
Animal studies confirm that glucocorticoid hormones effectively promote central compensation. Yamanaka and others demonstrated that after resecting unilateral vestibular neurons, glucocorticoid hormones enhanced anesthesia inhibition and spontaneous discharge in both anesthetized and awake animals. These results suggest that glucocorticoid hormones accelerate vestibular compensation by promoting compensatory activities in the vestibular nucleus neurons of animals with peripheral vestibular resection.
Summarizing the above analysis, glucocorticoid hormones play a therapeutic role in vestibular neuritis by promoting peripheral vestibular function recovery and accelerating vestibular compensation, supported by several double-blind, randomized controlled trials. They are currently the drug of choice for clinical treatment.
While antiviral drugs are commonly used based on the view that viral infections underlie vestibular neuritis, evidence-based medical evidence does not support antiviral therapy improving prognosis. Compared to placebo, antiviral therapy alone shows no statistically significant difference, whereas combining it with glucocorticoid steroid hormones can enhance efficacy, aligning with conclusions from other viral infection treatments like Bell's palsy. Early antiviral therapy showed no statistically significant difference in clinical efficacy compared to placebo, indicating that pathological changes caused by viral infections may already be irreversible at the start of treatment, and the effectiveness of existing antiviral drugs remains questionable.
Based on this evidence, antiviral therapy should not be included in evidence-based treatment modalities for vestibular neuritis. Vestibular rehabilitation training is an effective method to promote central vestibular compensation and is a more appropriate choice. Although some aspects of study are limited, further confirmation through more evidence-based medical research is needed.
In conclusion, using existing evidence-based medicine data, the initial treatment model for vestibular neuritis should include large doses of glucocorticoid treatment.