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Most patients with symptoms of vertigo have benign paroxysmal positional vertigo. About 7% have vestibular neuronitis, a syndrome with distinct pathologic findings of vestibular nerve inflammation or atrophy that is thought to have a vascular or viral cause. The formal diagnosis is made by caloric testing, but the clinical syndrome is distinct, with abrupt onset, severe vertigo, postural imbalance, and horizontal spontaneous nystagmus. In this study, 141 patients with vestibular neuronitis diagnosed by caloric testing were randomized to receive methylprednisolone (100 mg daily tapering to 10 mg daily over 22 days), the antiviral agent valacyclovir (1000 mg 3 times/day for 7 days), both agents, or placebo. Patients were evaluated using sophi…