Abstract：
A short course of corticosteroids is among the management strategies considered by specialists for the treatment of vestibular neuritis (VN). We conducted an umbrella review (systematic review of systematic reviews) to summarize the evidence of corticosteroids use for the treatment of VN.
We included systematic reviews of randomized controlled trials (RCTs) and observational studies that evaluated the effects of corticosteroids compared to placebo or usual care in adult patients with acute VN. Titles, abstracts, and full texts were screened in duplicate. The quality of reviews was assessed with the A MeaSurement Tool to Assess systematic Reviews (AMSTAR-2) tool. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) assessment was used to rate certainty of evidence. No meta-analysis was performed.
From 149 titles, five systematic reviews were selected for quality assessment, and two reviews were of higher methodological quality and were included. These two reviews included 12 individual studies and 660 patients with VN. In a meta-analysis of two RCTs including a total of 50 patients, the use of corticosteroids (compared to placebo) was associated with higher complete caloric recovery (risk ratio 2.81, 95% confidence interval [CI] 1.32 to 6.00, low certainty). It is very uncertain whether this translates into clinical improvement as shown by the imprecise effect estimates for outcomes such as patient-reported vertigo or patient-reported dizziness disability. There was a wide CI for the outcome of dizziness handicap score (one study, 30 patients, 20.9 points in corticosteroids group vs. 15.8 points in placebo, mean difference +5.1, 95% CI -8.09 to +18.29, very low certainty). Higher rates of minor adverse effects for those receiving corticosteroids were reported, but the certainty in this evidence was very low.
There is limited evidence to support the use of corticosteroids for the treatment of VN in the emergency department.
We included systematic reviews of randomized controlled trials (RCTs) and observational studies that evaluated the effects of corticosteroids compared to placebo or usual care in adult patients with acute VN. Titles, abstracts, and full texts were screened in duplicate. The quality of reviews was assessed with the A MeaSurement Tool to Assess systematic Reviews (AMSTAR-2) tool. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) assessment was used to rate certainty of evidence. No meta-analysis was performed.
From 149 titles, five systematic reviews were selected for quality assessment, and two reviews were of higher methodological quality and were included. These two reviews included 12 individual studies and 660 patients with VN. In a meta-analysis of two RCTs including a total of 50 patients, the use of corticosteroids (compared to placebo) was associated with higher complete caloric recovery (risk ratio 2.81, 95% confidence interval [CI] 1.32 to 6.00, low certainty). It is very uncertain whether this translates into clinical improvement as shown by the imprecise effect estimates for outcomes such as patient-reported vertigo or patient-reported dizziness disability. There was a wide CI for the outcome of dizziness handicap score (one study, 30 patients, 20.9 points in corticosteroids group vs. 15.8 points in placebo, mean difference +5.1, 95% CI -8.09 to +18.29, very low certainty). Higher rates of minor adverse effects for those receiving corticosteroids were reported, but the certainty in this evidence was very low.
There is limited evidence to support the use of corticosteroids for the treatment of VN in the emergency department.
摘要：
背景：短期糖皮质激素是治疗前庭神经炎（VN）专家考虑的治疗策略之一。我们进行了一项综述（系统评价的系统评价），以总结使用皮质类固醇治疗VN的证据。
方法：我们纳入了随机对照试验（RCT）和观察性研究的系统评价，这些研究评估了糖皮质激素与安慰剂或常规治疗对成年急性VN患者的影响。标题,摘要,全文一式两份。使用AMeaSurement工具评估系统评论（AMSTAR-2）工具评估评论的质量。建议的分级，评估,开发和评估（GRADE）评估用于评估证据的确定性。未进行荟萃分析。
结果：来自149个标题，选择了五项系统评价进行质量评估，两篇综述的方法学质量较高，被纳入。这两项综述包括12项个体研究和660例VN患者。在两项RCT的荟萃分析中，包括总共50名患者，使用皮质类固醇(与安慰剂相比)与更高的完全热量恢复相关(风险比2.81,95%置信区间[CI]1.32~6.00,低确定性).非常不确定这是否转化为临床改善，如患者报告的眩晕或患者报告的头晕残疾等结果的不精确效果估计所示。头晕障碍评分的结果有一个广泛的CI(一项研究，30名患者,皮质类固醇组的20.9分与安慰剂15.8分，平均差异+5.1，95%CI-8.09至+18.29，非常低的确定性)。据报道，接受皮质类固醇治疗的患者的轻微不良反应发生率较高，但是这个证据的确定性很低。
结论：支持在急诊科使用皮质类固醇治疗VN的证据有限。
方法：我们纳入了随机对照试验（RCT）和观察性研究的系统评价，这些研究评估了糖皮质激素与安慰剂或常规治疗对成年急性VN患者的影响。标题,摘要,全文一式两份。使用AMeaSurement工具评估系统评论（AMSTAR-2）工具评估评论的质量。建议的分级，评估,开发和评估（GRADE）评估用于评估证据的确定性。未进行荟萃分析。
结果：来自149个标题，选择了五项系统评价进行质量评估，两篇综述的方法学质量较高，被纳入。这两项综述包括12项个体研究和660例VN患者。在两项RCT的荟萃分析中，包括总共50名患者，使用皮质类固醇(与安慰剂相比)与更高的完全热量恢复相关(风险比2.81,95%置信区间[CI]1.32~6.00,低确定性).非常不确定这是否转化为临床改善，如患者报告的眩晕或患者报告的头晕残疾等结果的不精确效果估计所示。头晕障碍评分的结果有一个广泛的CI(一项研究，30名患者,皮质类固醇组的20.9分与安慰剂15.8分，平均差异+5.1，95%CI-8.09至+18.29，非常低的确定性)。据报道，接受皮质类固醇治疗的患者的轻微不良反应发生率较高，但是这个证据的确定性很低。
结论：支持在急诊科使用皮质类固醇治疗VN的证据有限。
