This presentation discusses the role of steroids in otolaryngology

1. Role of Steroids in otolaryngology Dr T Balasubramanian

3. These molecules readily diffuse across cell membrane into the cytoplasm

4. Inside the cytoplasm these molecules bind to the corticosteroid receptors present there.

5. The steroid-receptor complex acts on transcription factors

7. Causes a reduction in the amount of inflammatory cytokines secreted by the cell

8. Reduces the cells response to inflammation

9. Due to this complex mechanism of action there is a time delay between the administration of the drug and its clinical activity

10. Time delay of 3 hours is common

12. One hour is gained when the drug is administered intravenously

13. Drugs with minimal mineralocorticoid effect is preferred

14. Methylprednisolone / Dexamethasone are preferred as intravenous steroids

16. Prednisolone is preferred to prednisone (prodrug)

17. Prednisone needs to be metabolised in the liver into its active metabolites

18. Dexamethasone is the most potent oral steroid with very negligible mineralocorticoid effect

20. Its effect on the hypothalamic-pituitary-adrenal axis lasts for 3 weeks

21. Usually administered once in 3 weeks intramuscularly

22. Minimum plasma concentration after depo injection lasts for 3-4 weeks

24. First pass metabolism is avoided

25. Very low dose is enough for local effect – reduced systemic toxicity

26. On administration 50% of the drug stays in the non ciliated anterior part of the nose while the other 50% is in the posterior ciliated columnar portion of the nasal cavity

28. Beclamethasone dipropionate / budesonide are less lipophilic and hence are rapidly absorbed into the circulation when applied as topical spray

29. Spray administered in aqueous forms are better than aerosols.

30. Topical application is effective on itching and sneezing

31. Systemic application is better for blockage / anosmia

33. Vasomotor rhinitis

34. Nasal polyposis

35. Management of rhinitis medicamentosa

36. Idiopathic rhinitis

38. Parenteral

39. Depo (intramuscular)

41. Acute allergic rhinitis

42. Drug anaphylaxis

43. Acute sensorineural hearing loss (sudden deafness)

44. Treatment of acute hyposmia / anosmia

45. Acute stridor before tracheostomy

46. Acute epiglottitis

47. Croup

49. Bells palsy

50. Nasal sarcoidosis

51. Wegners granulomatosis

52. Thankyou

54. Used in the treatment of myringitis granulosa

55. Can be used to reduce middle ear mucosal oedema in active middle ear infections with central perforation

56. Long term use can cause atrophy of the skin lining of the external ear canal

58. Reassurance is a must and the drug should not be stopped

59. Dry nasal mucosa / crusts / blood stained discharge seen in patients on long term nasal steroid therapy

60. Prolonged usage may cause increased risk of cataract and osteoporosis