Efficacy of Vestibular Rehabilitation in Vestibular Neuritis: A Systematic Review and Meta-analysis.

When someone develops vestibular neuritis, a sudden inner-ear condition causing severe dizziness, clinicians often wonder whether exercise-based vestibular rehabilitation, steroid medication, or both together give the best recovery. This review pooled 12 randomized controlled trials covering 536 patients to compare these approaches using measures like the dizziness handicap inventory (a questionnaire scoring how much dizziness affects daily life) and tests of inner-ear function. The headline finding is that rehabilitation alone did not show a statistically significant difference from steroids alone across several follow-up points. But when rehabilitation was added on top of steroids, that combination showed statistically significant improvements over steroids alone at multiple time points, both in dizziness handicap scores and in objective balance-function tests.

The main limitation is that this is a modest evidence base drawn from a mix of trials rather than one large, uniform study, so caution is warranted before treating this as a settled answer.

If you've experienced vestibular neuritis, the sudden inner-ear condition that causes intense dizziness, you may have wondered whether exercises to retrain balance, steroid medication, or a combination works best. Researchers pooled results from 12 clinical trials involving 536 patients to look at this question, using a questionnaire that measures how much dizziness interferes with daily life, plus tests of inner-ear function. The review found no statistically significant difference between balance exercises alone and steroids alone at several points during recovery.

However, patients who received both balance exercises and steroids together showed statistically significant improvements compared to steroids alone, on the dizziness questionnaire and on inner-ear function tests, at various points in the first year. It's worth keeping in mind that this is based on a moderate number of combined trials rather than one single definitive study, so the findings give a useful picture but aren't the final word.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This review addresses whether vestibular rehabilitation adds value alongside, or substitutes for, steroid treatment in vestibular neuritis. Pooling 12 randomized controlled trials (536 patients), rehabilitation alone showed no statistically significant difference from steroids alone on dizziness handicap inventory scores at one, six, and twelve months, nor on caloric lateralization or vestibular-evoked myogenic potential abnormalities at the reported timepoints.

By contrast, rehabilitation combined with steroids showed statistically significant improvements over steroids alone in dizziness handicap scores at one, three, and twelve months, and in caloric lateralization and myogenic potential abnormalities at one and three months. This informs the clinical reasoning around whether to add rehabilitation to steroid-treated patients, with the combined-treatment comparison being the more decisive signal here, since the rehabilitation-versus-steroid comparison alone did not reach significance. The main limitation is that this synthesis rests on a moderate pooled sample from trials that likely vary in rehabilitation protocols and steroid regimens, and the abstract does not detail risk of bias or heterogeneity across the included studies, which constrains how firmly these pooled estimates should be applied to individual patient decisions.