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Prednisone Treatment for Vestibular Neuronitis

Primary Purpose

Vestibular Diseases, Vestibular Neuronitis

Status
Completed
Phase
Phase 2
Locations
Israel
Study Type
Interventional
Intervention
Prednisone
Prednisone
Sponsored by
Carmel Medical Center
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Vestibular Diseases focused on measuring Vestibular Neuronitis, Vestibular Function Tests, Vestibular Adaptation, Steroids

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Clinical diagnosis of vestibular neuronitis. Documentation of unilateral reduced caloric response (caloric asymmetry >25%) on the EOG caloric study. 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.

Sites / Locations

  • Unit of Otolaryngology Head and Neck Surgery, Hillel Yaffe Medical Center
  • Department of Otolaryngology Head and Neck Surgery, Rambam Medical Center
  • Department of Otolaryngology Head and Neck Surgery, Carmel Medical Center
  • Otoneurolgy Unit, Lin Medical Center, Clalit Health Services

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

1

2

Arm Description

Prednisone

Placebo

Outcomes

Primary Outcome Measures

Clinical: The presence of static and dynamic nystagmus, positional and positioning nystagmus, and disequilibrium on bedside examination.

Secondary Outcome Measures

Functional: Scores on the Dizziness Handicap Inventory questionnaires.
Laboratory: Caloric lateralization and directional preponderance on electro-oculography (EOG).

Full Information

First Posted
January 1, 2006
Last Updated
November 4, 2007
Sponsor
Carmel Medical Center
Collaborators
Clalit Health Services, Haifa and West Galilee, Hillel Yaffe Medical Center, Rambam Health Care Campus, University Health Network, Toronto
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1. Study Identification

Unique Protocol Identification Number
NCT00271791
Brief Title
Prednisone Treatment for Vestibular Neuronitis
Official Title
Prednisone Treatment for Vestibular Neuronitis
Study Type
Interventional

2. Study Status

Record Verification Date
July 2007
Overall Recruitment Status
Completed
Study Start Date
September 2005 (undefined)
Primary Completion Date
undefined (undefined)
Study Completion Date
May 2007 (Actual)

3. Sponsor/Collaborators

Name of the Sponsor
Carmel Medical Center
Collaborators
Clalit Health Services, Haifa and West Galilee, Hillel Yaffe Medical Center, Rambam Health Care Campus, University Health Network, Toronto

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
The purpose of the study is to investigate the value of steroids in the treatment of vestibular neuronitis. The potential benefits of steroid therapy would be analyzed by the clinical response, self-perceived handicap and laboratory parameters.
Detailed Description
Vestibular neuronitis is the second most common cause of peripheral vestibulopathy (the first being benign paroxysmal positional vertigo) with incidence of about 3.5/100000. Currently vestibular neuronitis is explained by a viral pathogenesis. Vestibular neuronitis is considered to have a benign course. The static rotatory vertigo and disequilibrium, present even when the patient is completely at rest, subside in most cases within a few days, and a gradual return to daily activities is the rule. However, it has been shown that there is generally incomplete restoration of peripheral function, and clinical recovery is achieved by proprioceptive and visual substitution for the unilateral vestibular deficit, combined with central vestibular compensation of the imbalance in vestibular tone. Although vestibular neuronitis is usually restricted to one attack, several studies have reported continuous or episodic vertigo or unsteadiness in 43% -53% of patients. The main residua include impaired vision and disequilibrium during walking and especially during head movement toward the affected ear. The rate of positive finding on vestibular evaluation may reach 60%. However, vestibular impairment as reflected by positive bedside testing and vestibular laboratory evaluation is not necessarily accompanied by subjective complaints and does not always reflect the level of incapacity. The assumed HSV-1 etiology of vestibular neuronitis and the reported benefit of the combination of steroids and acyclovir in Bell's palsy suggest similar advantage in the treatment of vestibular neuronitis. Also, glucocorticoid receptors activation was reported to enhance vestibular compensation after acute peripheral vestibular insults in various animal models. A recent study investigated the effect of prednisolone versus valacyclovir and placebo on canal paresis in vestibular neuronitis patients. It was found that steroid treatment significantly improved peripheral vestibular function to the extent reflected by the caloric testing. However, bedside findings, patients' complaints and daily handicap were not evaluated. The relevance of the EOG caloric test results to clinical improvement could be argued in light of a previous report showing no correlation between EOG findings and residual symptoms in a long-term follow-up of vestibular neuronitis patients, and the finding that corticosteroid therapy had no effect on symptoms despite significant recovery of the caloric-test results. The purpose of the study: Prospective controlled longitudinal 12-month evaluation of the value of steroids in the treatment of vestibular neuronitis. The potential benefits of steroid therapy would be analyzed by the clinical response, self-perceived handicap and EOG laboratory parameters.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Vestibular Diseases, Vestibular Neuronitis
Keywords
Vestibular Neuronitis, Vestibular Function Tests, Vestibular Adaptation, Steroids

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantInvestigator
Allocation
Randomized
Enrollment
17 (Actual)

8. Arms, Groups, and Interventions

Arm Title
1
Arm Type
Experimental
Arm Description
Prednisone
Arm Title
2
Arm Type
Placebo Comparator
Arm Description
Placebo
Intervention Type
Drug
Intervention Name(s)
Prednisone
Intervention Description
PO, 1 mg/kg body weight, 5 days Short tapering regimen: daily reductions in the dose, 12 days
Intervention Type
Drug
Intervention Name(s)
Prednisone
Intervention Description
PO, Placebo, 17 days
Primary Outcome Measure Information:
Title
Clinical: The presence of static and dynamic nystagmus, positional and positioning nystagmus, and disequilibrium on bedside examination.
Time Frame
12 months
Secondary Outcome Measure Information:
Title
Functional: Scores on the Dizziness Handicap Inventory questionnaires.
Time Frame
12 months
Title
Laboratory: Caloric lateralization and directional preponderance on electro-oculography (EOG).
Time Frame
12 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Clinical diagnosis of vestibular neuronitis. Documentation of unilateral reduced caloric response (caloric asymmetry >25%) on the EOG caloric study. 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.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Avi Shupak, MD
Organizational Affiliation
Carmel Medical Center and Clalit Health Services, Haifa and West Galilee
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Itzhak Braverman, MD
Organizational Affiliation
Hillel Yaffe Medical Center
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Avishai Golz, MD
Organizational Affiliation
Rambam Health Care Campus
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Elhanan Greenberg, ND
Organizational Affiliation
Carmel Medical Center
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Avi Shupak, MD
Organizational Affiliation
Carmel Medical Center and Clalit Health Services, Haifa and West Galilee
Official's Role
Study Chair
Facility Information:
Facility Name
Unit of Otolaryngology Head and Neck Surgery, Hillel Yaffe Medical Center
City
Hadera
ZIP/Postal Code
38100
Country
Israel
Facility Name
Department of Otolaryngology Head and Neck Surgery, Rambam Medical Center
City
Haifa
ZIP/Postal Code
31096
Country
Israel
Facility Name
Department of Otolaryngology Head and Neck Surgery, Carmel Medical Center
City
Haifa
ZIP/Postal Code
34362
Country
Israel
Facility Name
Otoneurolgy Unit, Lin Medical Center, Clalit Health Services
City
Haifa
ZIP/Postal Code
35152
Country
Israel

12. IPD Sharing Statement

Citations:
PubMed Identifier
15269315
Citation
Strupp M, Zingler VC, Arbusow V, Niklas D, Maag KP, Dieterich M, Bense S, Theil D, Jahn K, Brandt T. Methylprednisolone, valacyclovir, or the combination for vestibular neuritis. N Engl J Med. 2004 Jul 22;351(4):354-61. doi: 10.1056/NEJMoa033280.
Results Reference
background
PubMed Identifier
8470496
Citation
Ohbayashi S, Oda M, Yamamoto M, Urano M, Harada K, Horikoshi H, Orihara H, Kitsuda C. Recovery of the vestibular function after vestibular neuronitis. Acta Otolaryngol Suppl. 1993;503:31-4. doi: 10.3109/00016489309128067.
Results Reference
background
PubMed Identifier
2187486
Citation
Ariyasu L, Byl FM, Sprague MS, Adour KK. The beneficial effect of methylprednisolone in acute vestibular vertigo. Arch Otolaryngol Head Neck Surg. 1990 Jun;116(6):700-3. doi: 10.1001/archotol.1990.01870060058010.
Results Reference
background
PubMed Identifier
10482275
Citation
Arbusow V, Schulz P, Strupp M, Dieterich M, von Reinhardstoettner A, Rauch E, Brandt T. Distribution of herpes simplex virus type 1 in human geniculate and vestibular ganglia: implications for vestibular neuritis. Ann Neurol. 1999 Sep;46(3):416-9. doi: 10.1002/1531-8249(199909)46:33.0.co;2-w.
Results Reference
background
PubMed Identifier
10728930
Citation
Bergenius J, Perols O. Vestibular neuritis: a follow-up study. Acta Otolaryngol. 1999;119(8):895-9. doi: 10.1080/00016489950180243.
Results Reference
background
PubMed Identifier
12567089
Citation
Shupak A, Nachum Z, Stern Y, Tal D, Gil A, Gordon CR. Vestibular neuronitis in pilots: follow-up results and implications for flight safety. Laryngoscope. 2003 Feb;113(2):316-21. doi: 10.1097/00005537-200302000-00022.
Results Reference
background
PubMed Identifier
10373697
Citation
Cameron SA, Dutia MB. Lesion-induced plasticity in rat vestibular nucleus neurones dependent on glucocorticoid receptor activation. J Physiol. 1999 Jul 1;518(Pt 1):151-8. doi: 10.1111/j.1469-7793.1999.0151r.x.
Results Reference
background
PubMed Identifier
11094095
Citation
Fife TD, Tusa RJ, Furman JM, Zee DS, Frohman E, Baloh RW, Hain T, Goebel J, Demer J, Eviatar L. Assessment: vestibular testing techniques in adults and children: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 2000 Nov 28;55(10):1431-41. doi: 10.1212/wnl.55.10.1431. No abstract available.
Results Reference
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Prednisone Treatment for Vestibular Neuronitis

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