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Oral administration of prednisone to control refractory vertigo in Ménière's disease: a pilot study
The beneficial effect of methylprednisolone in acute vestibular vertigo
- Prednisone for vertigo
The purpose of the study: Prospective controlled longitudinal month evaluation of the value of steroids in the treatment of vestibular neuronitis. Drug Information available for: Prednisone. FDA Resources. Arms and Interventions. Outcome Measures. Primary Outcome Measures : Clinical: The presence of static and dynamic nystagmus, positional and positioning nystagmus, and disequilibrium on bedside examination. Eligibility Criteria. Information from the National Library of Medicine Choosing to participate in a study is an important personal decision.
Inclusion Criteria: Clinical diagnosis of vestibular neuronitis. Exclusion Criteria: Complaints of new hearing loss, tinnitus, or neurological deficits. The presence of previously non-diagnosed sensorineural hearing loss SNHL History of vestibular dysfunction. Patient younger than 18 years of age.
Known contra-indication to systemic steroids: Unbalanced hypertension, un-controlled diabetes mellitus, immunodeficiency, active peptic disease, and avascular necrosis of the femoral head.
Contacts and Locations. Information from the National Library of Medicine To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor. Please refer to this study by its ClinicalTrials.
More Information. Methylprednisolone, valacyclovir, or the combination for vestibular neuritis. N Engl J Med. Recovery of the vestibular function after vestibular neuronitis. Acta Otolaryngol Suppl. The beneficial effect of methylprednisolone in acute vestibular vertigo.
Arch Otolaryngol Head Neck Surg. Distribution of herpes simplex virus type 1 in human geniculate and vestibular ganglia: implications for vestibular neuritis. Ann Neurol. Bergenius J, Perols O. Vestibular neuritis: a follow-up study. Acta Otolaryngol. The electronystagmogram returned to normal within 1 month in all 16 patients taking methylprednisolone, but remained abnormal in 2 of the 4 patients treated with placebo.
From this double-blind, prospective, placebo-controlled, crossover study, we conclude that methylprednisolone is much more effective than placebo in reducing vertiginous symptoms in patients with acute vestibular vertigo. Abstract To assess the efficacy of corticosteroids in acute vestibular vertigo, we randomly selected 20 patients so that half took methylprednisolone and half took placebo.
Steroids can be used to reduce inner ear inflammation and settle down hydrops in acute situations. It can be dramatically effective for the immediate problem.
However, due to side-effects, we do not use it long term. Caution: Steroids can have, but are not limited to the following side effects: GI upset, gastritis, ulcers take with meals insomnia and irritability and mood changes. Prolonged use may cause weight gain, rounded face, body changes, adrenal suppression and possible hip problems. All Rights Reserved.
In an acute attack, we use medications that dull the sensation of vertigo using: Antivert: 1 tablet every 8 hours or as needed. Droperidol: drops under the tongue during severe attacks.
Timothy C. Steroids are commonly prescribed for sudden hearing loss as well as for autoimmune inner ear disease and vestibular neuritis. The purpose of this page is to outline the usual methodology. We do not discuss their effectiveness or the validity of their indications. There is very little difference with respect to the ultimate results with these drugs and side effects, but they differ in potency and duration of action, and for this reason, the dose must be adjusted.
Oral decadron would seem to us to be a poor choice for a condition in which rapid effects are desirable such as acute hearing loss or vestibular neuritis, as due to it's long half life, it takes 20 days to reach steady state. Of course, one can adjust one's protocol to give more drug at the beginning, as is the case for the "medrol dose pack".
The most common method of administration is by mouth. We will not discuss intravenous administration faster and stronger, sometimes used for situations where symptoms are very severe such as bilateral deafness associated with autoimmune inner ear disease. Administration through the ear-drum is discussed elsewhere. This method has the advantage of much less side effects, but the disadvantages of higher expense and the need for a subspecialty visit for injection through the ear drum. For the oral method, there are four common protocols that we use in our clinic :.
The easiest, safest, and most convenient method of trying steroids is to use a medrol methylprednisolone dose pack. This is a card that contains 6 days of steroids, with less provided each day. The gradual decrease in the amount of steroids each day is called a "taper". The reason to do this is to allow the patient's adrenal glands, which are usually suppressed by the steroids, to gradually return to supplying steroids to the patient on their own.
Medrol is slightly stronger than prednsone, so to convert this into "prednisone", when using the 4 mg dose-pack, one just has to multiple by 5. In other words, the medrol dose pack is the equivalent of 30 mg of prednisone, tapering down to 0 over a week. For persons in whom a larger amount of steroids is indicated a longer protocol and more intense protocol is selected. Longer pulses require longer tapers. Checking the blood pressure to make sure it is not dropping too low and follow up visits during the taper period are often required.
Some patients are "steroid dependent". For example, whenever the steroid dose is decreased below a threshold, hearing starts to deteriorate again. In patients like this, an attempt is made to find a steroid sparing replacement drug such as methotrexate or Enbrelbut in the meantime, the steroids are reduced to as low an amount as is practical.
Steroids have many side effects, that are more common with longer administration. Common ones in the short run i. Problems that can occur after longer administration, besides the ones that may appear above, include.
The drugs that are most commonly used include: Drug Equivalent mg Half life Usual starting dose dexamethasone decadron 0. Deterioration or temporary induction of diabetes, high blood sugar Sleeplessness, mood swings Problems that can occur after longer administration, besides the ones that may appear above, include Weight gain with swelling in ankles and fat accumulation around center of body, moon face.
Weakness in legs steroid myopathy Cataracts Increased risk of infections Suppression of adrenal glands, low blood pressure and other problems during taper. Bruising, thin skin. Byl FM. Sprague MS. Lesion-induced plasticity in rat vestibular nucleus neurones dependent on glucocorticoid receptor activation.
J Physiol ; Pt 1 Kitahara T. Kondoh K. Morihana T. Neurol Res ;25 3 Ohbayashi S. Oda M. Yamamoto M. Recovery of the vestibular function after vestibular neuronitis.
Acta Otolaryngol. Corticosteroids effect on vestibular neuritis symptom relief. Issa A. Golz A. Prednisone treatment for vestibular neuritis. Otol Neurotol. Zingler VC. Arbusow V. Methylprednisolone, valacyclovir, or the combination for vestibular neuritis.
N Engl J Med.
From this double-blind, prospective, placebo-controlled, crossover study, we conclude that methylprednisolone is much more effective than placebo in reducing. Steroids for Hearing Loss or Vertigo ; dexamethasone (decadron), , 48 (), 4mg (equivalent of 20mg of prednisone, but with longer. It is, after benign paroxysmal vertigo, the second most common cause of to 50 mg prednisone) daily for 5 days, and then tapering by 10 mg/d for the next. Prednisone: 10 mg tablets in an as directed manner. Dexamethasone: 4 mg daily for 2 weeks, then mg every other day for 1 month. Although steroids have some beneficial effects in acute vertigo syndromes such as Ménière disease, they seem to have no value in the treatment. Eligibility Criteria. The reason to do this is to allow the patient's adrenal glands, which are usually suppressed by the steroids, to gradually return to supplying steroids to the patient on their own. Information from the National Library of Medicine To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor. We do not discuss their effectiveness or the validity of their indications.To assess the efficacy of corticosteroids in acute vestibular vertigo, we randomly selected 20 patients so that half took methylprednisolone and half took placebo. Extensive neurotologic examination confirmed the diagnosis. If no significant reduction of vertigo occurred within the first 24 hours of treatment, patients were instructed to switch medications.
Patients were followed up prospectively for 1 month. Of the 10 patients receiving methylprednisolone, 9 had a marked reduction of vertiginous symptoms and 1 switched to the placebo medication.
Of the 10 patients receiving placebo, 3 had relief of vertiginous symptoms, while the 7 with persistent symptoms switched to methylprednisolone and had subsequent effective reduction of vertigo within 24 hours.
The electronystagmogram returned to normal within 1 month in all 16 patients taking methylprednisolone, but remained abnormal in 2 of the 4 patients treated with placebo. From this double-blind, prospective, placebo-controlled, crossover study, we conclude that methylprednisolone is much more effective than placebo in reducing vertiginous symptoms in patients with acute vestibular vertigo.
Abstract To assess the efficacy of corticosteroids in acute vestibular vertigo, we randomly selected 20 patients so that half took methylprednisolone and half took placebo.
Substances Methylprednisolone.
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