Role of Steroids in

otolaryngology
Dr T
Balasubramanian

Introduction

Corticosteroids are small lipophilic molecules

These molecules readily diffuse across cell

membrane into the cytoplasm

Inside the cytoplasm these molecules bind to the

corticosteroid receptors present there.

The steroid-receptor complex acts on transcription

factors

Action of steroid-receptor complex

This activated complex acts on transcription proteins

found inside the cytoplasm

Causes a reduction in the amount of inflammatory

cytokines secreted by the cell

Reduces the cells response to inflammation

Due to this complex mechanism of action there is a

time delay between the administration of the drug
and its clinical activity

Time delay of hours is common

Intravenous steroids

!seful during emergencies

"ne hour is gained when the drug is administered

intravenously

Drugs with minimal mineralocorticoid effect is

preferred

#ethylprednisolone $ Dexamethasone are preferred

as intravenous steroids

Oral steroids

!sed in patients who need long term administration

of the drug

%rednisolone is preferred to prednisone &prodrug'

%rednisone needs to be metabolised in the liver into

its active metabolites

Dexamethasone is the most potent oral steroid with

very negligible mineralocorticoid effect

Depo injections - IM

#ethyl prednisolone acetate is commonly used

Its effect on the hypothalamic-pituitary-adrenal axis

lasts for weeks

!sually administered once in weeks

intramuscularly

#inimum plasma concentration after depo in(ection

lasts for -) weeks

Intranasal steroids

Intranasally adeministered steroid should be

lipophilic

*irst pass metabolism is avoided

+ery low dose is enough for local effect , reduced

systemic toxicity

"n administration -./ of the drug stays in the non

ciliated anterior part of the nose while the other -./
is in the posterior ciliated columnar portion of the
nasal cavity

Intranasal steroid (contd)

*luticasone propionate commonly used. 0ighly

lipophilic and has a large tissue distribution volume

1eclamethasone dipropionate $ budesonide are less

lipophilic and hence are rapidly absorbed into the
circulation when applied as topical spray

2pray administered in a3ueous forms are better than

aerosols.

Topical application is effective on itching and

snee4ing

2ystemic application is better for blockage $ anosmia

Nasal topical steroids indications

5llergic rhinitis

+asomotor rhinitis

6asal polyposis

#anagement of rhinitis medicamentosa

Idiopathic rhinitis

Systemic steroids

"ral

%arenteral

Depo &intramuscular'

Systemic steroids indications

5ngioneurotic oedema

5cute allergic rhinitis

Drug anaphylaxis

5cute sensorineural hearing loss &sudden deafness'

Treatment of acute hyposmia $ anosmia

5cute stridor before tracheostomy

5cute epiglottitis

Croup

Systemic steroids indications (contd)

"titis externa , to reduce external canal

inflammatory oedema

1ells palsy

6asal sarcoidosis

7egners granulomatosis

Thankyou

Steroid ear drops

!sed to treat ec4ematous conditions of the skin

lining fo external canal

!sed in the treatment of myringitis granulosa

Can be used to reduce middle ear mucosal oedema

in active middle ear infections with central
perforation

8ong term use can cause atrophy of the skin lining

of the external ear canal

Intranasal steroid (contd)

Topical steroids when used on hyper reactive nose

can cause increased snee4ing

Reassurance is a must and the drug should not be

stopped

Dry nasal mucosa $ crusts $ blood stained discharge

seen in patients on long term nasal steroid therapy

%rolonged usage may cause increased risk of

cataract and osteoporosis