Corticosteroids in ENT

Corticosteroid medications are among the most widely used and clinically valuable drugs in medicine. In otolaryngology they are used to reduce inflammation in a range of conditions — from acute tonsillitis and sudden hearing loss through to chronic sinusitis and nasal polyps. They are effective but not without side effects, and understanding those side effects is an important part of using them safely.

One important clarification at the outset: corticosteroid medications are entirely different from the anabolic steroids used in sport and bodybuilding. They do not build muscle mass and have no performance-enhancing effect. The confusion arises from the shared word “steroid” but they are chemically and functionally distinct classes of medication.

What Are Corticosteroids?

Corticosteroids are a class of steroid hormones naturally produced by the adrenal cortex — the outer layer of the adrenal glands, which sit above the kidneys. The body produces corticosteroids continuously to regulate a wide range of physiological processes including metabolism, immune function, inflammation response, salt and water balance, and the stress response. Cortisol is the principal naturally occurring corticosteroid.

Synthetic corticosteroids — including prednisolone, prednisone, dexamethasone, and methylprednisolone — are pharmaceutical copies of the body’s own cortisol, modified to be more potent or longer-acting. They work by binding to glucocorticoid receptors throughout the body, suppressing inflammatory pathways and modulating immune responses.

Forms of Corticosteroids Used in ENT

ENT Conditions That May Be Treated with Corticosteroids

Oral corticosteroids are used in the following ENT contexts:

• Sudden sensorineural hearing loss — high-dose oral prednisolone is the primary treatment and should be commenced as a matter of urgency; delay reduces the chance of hearing recovery
• Glandular fever (infectious mononucleosis) with severe tonsillar swelling — a short course reduces tonsillar oedema and the risk of airway compromise
• Severe acute rhinosinusitis — a short course may reduce severe mucosal swelling and alleviate symptoms
• Chronic rhinosinusitis with nasal polyps — a short reducing course (oral steroid taper) can dramatically shrink polyps before endoscopic sinus surgery, or as a non-surgical management option in selected patients
• Severe allergic reactions affecting the airway — corticosteroids are part of the acute management of severe allergic or angio-oedematous swelling
• Post-operative inflammation — short perioperative courses are used selectively after certain ENT procedures to reduce swelling

Side Effects of Oral Corticosteroids

The following side effects relate to oral corticosteroids. Topical nasal sprays used correctly at standard doses do not cause these effects.

Patients with diabetes should monitor their blood glucose more carefully during a course of oral corticosteroids and discuss management with their GP or endocrinologist if the course is prolonged. Patients on regular oral corticosteroids for other conditions should inform Dr Roth before any ENT procedure, as the dose may need to be adjusted perioperatively.

Are There Alternatives?

In most ENT contexts, corticosteroids are not the only option — and in many cases, they are not essential. The decision to prescribe them weighs the expected clinical benefit against the side effect profile and the availability of alternatives.

For nasal polyps and chronic sinusitis, topical intranasal steroids are the cornerstone of long-term management and are preferred over repeated oral courses. Endoscopic sinus surgery — which removes the polyps and opens the sinus drainage pathways — can reduce or eliminate the need for ongoing oral steroid courses in many patients.

For sudden hearing loss, there is no established alternative to corticosteroids as first-line treatment; the evidence for prompt high-dose oral prednisolone is the strongest available for any intervention in this condition.

For glandular fever and acute tonsillitis, corticosteroids are used selectively rather than routinely — for severe presentations with significant airway compromise rather than as a standard treatment for every patient.

Sudden sensorineural hearing loss →  |  Chronic sinusitis →  |  Tonsillitis →  |  Arrange a Consultation →