Efficacy of Pharmacological and Non-pharmacological Interventions in Vestibular Neuritis: A Systematic Review and Network Meta-analysis
Muneeb Ahmad Muneer1, Malavika Rudrakumar2, Victor Ghosh3, Dabbara Venkata Ramana4, Anmol Kaur5, Hariharan Seshadri6
1Allama Iqbal Medical College, 2St. John's medical college, 3Andhra Medical College, 4Osmania medical college, 5Lady Hardinge Medical College and Associated Hospitals, 6Madras Medical College
Objective:
To assess the relative efficacy of different treatment options for the management of vestibular neuritis.
Background:
Vestibular neuritis is an inner ear disorder characterized by vertigo, dizziness, and nausea, caused by inflammation of the vestibular nerve. Symptoms such as severe vertigo, imbalance, nausea, and vomiting can severely affect daily life. Current treatment options include vestibular rehabilitation exercises, anti-nausea medications, and corticosteroids. However, comprehensive efficacy studies on these treatments are lacking, underscoring the need for a network meta-analysis to evaluate their effectiveness.
Design/Methods:
A comprehensive systematic search was conducted in PubMed/MEDLINE, EMBASE, Scopus, and ClinicalTrials.gov to identify Randomized Controlled Trials (RCTs) evaluating interventions for Vestibular Neuritis. The search included studies from the earliest available date up to April 2024. The primary outcome was the Dizziness Handicap Inventory (DHI) score. Pairwise and network meta-analyses were performed using the frequentist approach to derive both direct and indirect comparisons, expressed as standardized mean differences (SMD).
Results:
In the analysis of the primary outcome, the Dizziness Handicap Inventory (DHI) score, 7 trials were included with a pooled population of 381, leading to approximately 11 pairwise comparisons. Vestibular rehabilitation therapy (VRT) combined with corticosteroid therapy (CST) and semicircular canal stimulation training (SCCST) (VRT+CST+SCCST) demonstrated a statistically significant SMD of −1.80 (95% CI: −3.12, −0.47). VRT alone also showed a significant SMD of −1.06 (95% CI: −1.89, −0.23). In contrast, CST alone had an SMD of −0.29 (95% CI: −1.04, 0.47), which was not statistically significant. The combination of VRT and CST yielded an SMD of −0.87 (95% CI: −1.84, 0.10), which was also statistically insignificant.
Conclusions:
VRT+CST+SCCST demonstrated significant improvement in the DHI score, followed by VRT alone. CST combined with VRT yielded better results compared to CST alone. Further research is needed to validate these findings.
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