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Vestibular neuritis is characterized by acute vertigo, postural imbalance, and nausea, but residual symptoms can persist for months or years. Patients sometimes are treated with steroids (because of presumed inflammation of the vestibular nerve) or antiviral drugs (because reactivated herpes simplex virus is a presumed cause). However, neither treatment has been studied adequately.
In this German trial, 141 patients with acute vestibular neuritis were randomized to receive methylprednisolone (3-week tapering course starting with 100 mg daily), valacyclovir (1000 mg three times daily for 1 week), both drugs, or placebo. The baseline extent of vestibular paresis in all 4 groups averaged about 79%, as determined by computer analysis of caloric …