Steroids ent

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 3 hours is common

Intravenous steroids
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

Oral steroids
Used in patients who need long term administration of the drug
Prednisolone is preferred to prednisone (prodrug)
Prednisone 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
Methyl prednisolone acetate is commonly used
Its effect on the hypothalamic-pituitary-adrenal axis lasts for 3 weeks
Usually administered once in 3 weeks intramuscularly
Minimum plasma concentration after depo injection lasts for 3-4 weeks

Intranasal steroids
Intranasally adeministered steroid should be lipophilic
First pass metabolism is avoided
Very low dose is enough for local effect – reduced systemic toxicity
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

Intranasal steroid (contd)
Fluticasone propionate commonly used. Highly lipophilic and has a large tissue distribution volume
Beclamethasone dipropionate / budesonide are less lipophilic and hence are rapidly absorbed into the circulation when applied as topical spray
Spray administered in aqueous forms are better than aerosols.
Topical application is effective on itching and sneezing
Systemic application is better for blockage / anosmia

Nasal topical steroids indications
Allergic rhinitis
Vasomotor rhinitis
Nasal polyposis
Management of rhinitis medicamentosa
Idiopathic rhinitis

Systemic steroids
Oral
Parenteral
Depo (intramuscular)

Systemic steroids indications
Angioneurotic oedema
Acute allergic rhinitis
Drug anaphylaxis
Acute sensorineural hearing loss (sudden deafness)
Treatment of acute hyposmia / anosmia
Acute stridor before tracheostomy
Acute epiglottitis
Croup

Systemic steroids indications (contd)
Otitis externa – to reduce external canal inflammatory oedema
Bells palsy
Nasal sarcoidosis
Wegners granulomatosis

Thankyou

Steroid ear drops
Used to treat eczematous conditions of the skin lining fo external canal
Used in the treatment of myringitis granulosa
Can be used to reduce middle ear mucosal oedema in active middle ear infections with central perforation
Long 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 sneezing
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
Prolonged usage may cause increased risk of cataract and osteoporosis

Steroids ent

by Balasubramanian Thiagarajan on Mar 26, 2011

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Steroids ent — Presentation Transcript