Role of Steroids in otolaryngology Dr T Balasubramanian
Introduction <ul><li>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 </li></ul>
Action of steroid-receptor complex <ul><li>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 acti...
Time delay of 3 hours is common </li></ul>
Intravenous steroids <ul><li>Useful during emergencies
One hour is gained when the drug is administered intravenously
Drugs with minimal mineralocorticoid effect is preferred
Methylprednisolone / Dexamethasone are preferred as intravenous steroids </li></ul>
Oral steroids <ul><li>Used in patients who need long term administration of the drug
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Steroids ent

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This presentation discusses the role of steroids in otolaryngology

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Steroids ent

  1. 1. Role of Steroids in otolaryngology Dr T Balasubramanian
  2. 2. Introduction <ul><li>Corticosteroids are small lipophilic molecules
  3. 3. These molecules readily diffuse across cell membrane into the cytoplasm
  4. 4. Inside the cytoplasm these molecules bind to the corticosteroid receptors present there.
  5. 5. The steroid-receptor complex acts on transcription factors </li></ul>
  6. 6. Action of steroid-receptor complex <ul><li>This activated complex acts on transcription proteins found inside the cytoplasm
  7. 7. Causes a reduction in the amount of inflammatory cytokines secreted by the cell
  8. 8. Reduces the cells response to inflammation
  9. 9. Due to this complex mechanism of action there is a time delay between the administration of the drug and its clinical activity
  10. 10. Time delay of 3 hours is common </li></ul>
  11. 11. Intravenous steroids <ul><li>Useful during emergencies
  12. 12. One hour is gained when the drug is administered intravenously
  13. 13. Drugs with minimal mineralocorticoid effect is preferred
  14. 14. Methylprednisolone / Dexamethasone are preferred as intravenous steroids </li></ul>
  15. 15. Oral steroids <ul><li>Used in patients who need long term administration of the drug
  16. 16. Prednisolone is preferred to prednisone (prodrug)
  17. 17. Prednisone needs to be metabolised in the liver into its active metabolites
  18. 18. Dexamethasone is the most potent oral steroid with very negligible mineralocorticoid effect </li></ul>
  19. 19. Depo injections - IM <ul><li>Methyl prednisolone acetate is commonly used
  20. 20. Its effect on the hypothalamic-pituitary-adrenal axis lasts for 3 weeks
  21. 21. Usually administered once in 3 weeks intramuscularly
  22. 22. Minimum plasma concentration after depo injection lasts for 3-4 weeks </li></ul>
  23. 23. Intranasal steroids <ul><li>Intranasally adeministered steroid should be lipophilic
  24. 24. First pass metabolism is avoided
  25. 25. Very low dose is enough for local effect – reduced systemic toxicity
  26. 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 </li></ul>
  27. 27. Intranasal steroid (contd) <ul><li>Fluticasone propionate commonly used. Highly lipophilic and has a large tissue distribution volume
  28. 28. Beclamethasone dipropionate / budesonide are less lipophilic and hence are rapidly absorbed into the circulation when applied as topical spray
  29. 29. Spray administered in aqueous forms are better than aerosols.
  30. 30. Topical application is effective on itching and sneezing
  31. 31. Systemic application is better for blockage / anosmia </li></ul>
  32. 32. Nasal topical steroids indications <ul><li>Allergic rhinitis
  33. 33. Vasomotor rhinitis
  34. 34. Nasal polyposis
  35. 35. Management of rhinitis medicamentosa
  36. 36. Idiopathic rhinitis </li></ul>
  37. 37. Systemic steroids <ul><li>Oral
  38. 38. Parenteral
  39. 39. Depo (intramuscular) </li></ul>
  40. 40. Systemic steroids indications <ul><li>Angioneurotic oedema
  41. 41. Acute allergic rhinitis
  42. 42. Drug anaphylaxis
  43. 43. Acute sensorineural hearing loss (sudden deafness)
  44. 44. Treatment of acute hyposmia / anosmia
  45. 45. Acute stridor before tracheostomy
  46. 46. Acute epiglottitis
  47. 47. Croup </li></ul>
  48. 48. Systemic steroids indications (contd) <ul><li>Otitis externa – to reduce external canal inflammatory oedema
  49. 49. Bells palsy
  50. 50. Nasal sarcoidosis
  51. 51. Wegners granulomatosis </li></ul>
  52. 52. Thankyou
  53. 53. Steroid ear drops <ul><li>Used to treat eczematous conditions of the skin lining fo external canal
  54. 54. Used in the treatment of myringitis granulosa
  55. 55. Can be used to reduce middle ear mucosal oedema in active middle ear infections with central perforation
  56. 56. Long term use can cause atrophy of the skin lining of the external ear canal </li></ul>
  57. 57. Intranasal steroid (contd) <ul><li>Topical steroids when used on hyper reactive nose can cause increased sneezing
  58. 58. Reassurance is a must and the drug should not be stopped
  59. 59. Dry nasal mucosa / crusts / blood stained discharge seen in patients on long term nasal steroid therapy
  60. 60. Prolonged usage may cause increased risk of cataract and osteoporosis </li></ul>
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