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Steroids ent

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This presentation discusses the role of steroids in otolaryngology

This presentation discusses the role of steroids in otolaryngology

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  • 1. Role of Steroids in otolaryngology Dr T Balasubramanian
  • 2. Introduction
    • Corticosteroids are small lipophilic molecules
    • 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
  • 6. Action of steroid-receptor complex
    • This activated complex acts on transcription proteins found inside the cytoplasm
    • 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
  • 11. Intravenous steroids
    • Useful during emergencies
    • 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
  • 15. Oral steroids
    • Used in patients who need long term administration of the drug
    • 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
  • 19. Depo injections - IM
    • Methyl prednisolone acetate is commonly used
    • 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
  • 23. Intranasal steroids
    • Intranasally adeministered steroid should be lipophilic
    • 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
  • 27. Intranasal steroid (contd)
    • Fluticasone propionate commonly used. Highly lipophilic and has a large tissue distribution volume
    • 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
  • 32. Nasal topical steroids indications
    • Allergic rhinitis
    • 33. Vasomotor rhinitis
    • 34. Nasal polyposis
    • 35. Management of rhinitis medicamentosa
    • 36. Idiopathic rhinitis
  • 37. Systemic steroids
  • 40. Systemic steroids indications
    • Angioneurotic oedema
    • 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
  • 48. Systemic steroids indications (contd)
    • Otitis externa – to reduce external canal inflammatory oedema
    • 49. Bells palsy
    • 50. Nasal sarcoidosis
    • 51. Wegners granulomatosis
  • 52. Thankyou
  • 53. Steroid ear drops
    • Used to treat eczematous conditions of the skin lining fo external canal
    • 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
  • 57. Intranasal steroid (contd)
    • Topical steroids when used on hyper reactive nose can cause increased sneezing
    • 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

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