Corticosteroids in ENT
When you are prescribed a steroid medication, this usually means a “corticosteroid” medication. Corticosteroid medications are very useful medications that are widely used in medicine. They are used as part of treatment for a number of Ear, Nose and Throat conditions. Like all medications they have some side effects. These can occasionally be serious but are rare. The type of steroid medication we prescribe is different to the “anabolic steroids” used by bodybuilders and will not cause you to gain muscle mass.
What are corticosteroids?
Corticosteroids are a naturally occurring hormone made by the human body to regulate a whole range of body processes. These include effects on metabolism and the immune system. Synthetic corticosteroids (eg prednisone) are a copy of the human hormone.
Corticosteroid medications can be taken in the form of nasal sprays, inhalers or tablets. When we compare different types of steroids and delivery the important differences are how strong the steroid is (the affinity) and how much is absorbed into the bloodstream.
Are nasal steroid sprays safe?
As a general rule, topical steroid sprays (Nasonex, Omnaris, Avamys, Rhinocort) are not absorbed into the blood stream and do not cause the side effects that other types of steroids cause. They are extremely safe, even in children. They can be used in children for years without any harmful effects. They can cause nose bleeds if not used correctly.
Dr Roth sometimes prescribes types of steroid rinses that contain higher doses of steroid than standard steroid sprays. An example of this is budesonide respules dissolved in a sinus rinse bottle. A small amount of this steroid is typically absorbed into the body. This type of treatment is reserved for very specific cases (eg. nasal polyp recurrence) and is generally not continued indefinitely without break periods.
What types of Ear, Nose and Throat Conditions may need treatment with corticosteroids?
- Glandular fever, viral tonsillitis (1 to 2 weeks)
- Chronic rhinosinusitis (up to 4 weeks)
- Very severe acute rhinosinusitis (1 week)
- Sudden hearing loss (1 to 2 weeks)
In other medical specialties, corticosteroids may be useful to treat
- Chronic systemic diseases (eg Crohn’s disease, Ulcerative Collitis)
- Treatment of cancers
What are the potential side effects?
- Increased appetite
- Sleep disturbance or nightmares
- Mood swings
- Disturbed sugar control in patients with Diabetes
- Weight redistribution to the face (15% of patients after 3 months of treatment)
- Abdominal discomfort
- Skin thinning (after many years of use)
- Osteoporosis (after many years of use)
- Delayed wound healing
- Cataracts, glaucoma
- Avascular necrosis of the hip. A very rare arthritis that may require surgery.
Are their alternatives to using steroids?
Apart from a very small number of life threatening Ear, Nose and Throat conditions, steroids are usually not life saving. They can be very effective in treating disease and preventing the need for surgery. There may be other medications or treatment options, including surgery, that can avoid the need to use steroid medications.
Download this information as a .pdf file for printing and reference here – Corticosteroid Medications