Strengths and limitations
The strength of this meta-analysis is that the effect of corticosteroids was analyzed for each period of recovery from acute vestibular syndrome. As previously reported, the effect of steroids on VN patients is likely to vary by time of recovery from acute vestibular syndrome. Therefore, we analyzed the effectiveness of corticosteroids over time as the vestibular function recovers. The second strength is that functional restoration and symptomatic improvement were separately analyzed in this meta-analysis. Patients with compensated peripheral vestibulopathy often have few or no symptoms (even if a permanent functional deficit remains). We analyzed the caloric result and DHI score as a representative functional test and a validated questionnaire, respectively.
This meta-analysis has several shortcomings. First, the potential influence of combined treatment on steroid therapy cannot be excluded. Although we included studies in which the steroid group and non-steroid group underwent the same combined treatment, it is possible that these treatments affected the effect of steroids. Second, there are many types of steroid therapy protocols, which may have differed between studies. This difference between studies was not adjusted in our study. Finally, there were no data regarding the results of the more physiologic vestibular function tests, because no reported controlled studies evaluated rotation chair or video head impulse tests.