Corticosteroids readily diffuse into cells and bind with glucocorticoid receptors to form complexes that interact with proteins and act as transcription factors, reducing inflammation. Intranasal corticosteroids become effective within 3 hours and are most effective for symptoms like itching and sneezing, while systemic corticosteroids are more effective for blockage and anosmia. Methylprednisolone and dexamethasone are preferred for intravenous use due to their minimal mineralocorticoid effects. Prednisone is converted to prednisolone in the liver, while dexamethasone has minimal mineralocorticoid effects.

1. Corticosteroid in Otolaryngology
Corticosteroid are small lipophilic molecules that readily diffuse across the cell membrane into
cytoplasm. Then bind with Glucocorticod recptor .Corticosteroid-glucocorticoid recptor complex
interact with protein , act as transcription factor. Reduced synthethesis of inflammatory cytokine&
reduce the number &activity of imflammatory cells.
Clinical effect of an intranasal corticosteroid steroid starts as early as 3hrs after
application.Density of receptor molecule varies.Topical treatment is most effective on Itching&
sneezing. Systemic on blockage &anosmia.
Intravenous Corticosteroids
Methylprenisolone or Dexamethasone are preferred as they have minimal mineralocorticoid
effect.when adrenal insufficiency is suspected in a patient on long term oral treatment
,hydrocortisone is the drug of choice.
Oral Corticosteroid
Prednisone>→ Prednisolone(Liver)
Dexamethasone have minimal mineralocorticoids effect.
Intramuscular Depot Inj. Of CS
When depot inj Methylprednisolone, Maximum effect occur after 3days &last upto 3wks.
inj Methylprednisolone 80mg equivalent to 100mg Prednisolone orally.
Intranasal Corticosteroid
When an aqueous spray is used,50% deposited in nostril nonciliated part,50% will reach the
ciliated mucous membrane,Where it is absorbed or removed by mucociliary clearance within 30
minutes.
Highly lipophilic molecules fluticasone propionate&Mometasone have large tissue
distribution volume. Consequently highly lipophilic molecule have a long elimination time,
Use both the drugs for 10 to30yrs minimal systemic side effect ,when used once daily in the
morning at recommended dose.
Intranasal corticosteroid
Flunisolide/Budesonide/ Fluticasone /mometasone/Triamcinolone>As these drugs don’t
differ significantly with regards to effect & risk of side effect,It is recommended to choose the
cheapest drug.
Continuouse treatment can be replaced by periodic treatment for 2 to 6wks.( used fir 30 yrs
virtually no adverse effect)

2. Should not be given Children/ pregnant women/Dm/ Severe osteoposis /glaucoma /cataract.
Depot inj have shown marked effect on nasal blockage lasting for 4wks than oral C/S.The
treatment can be added when intranasal C/S is insufficient. 80mg Depot Mehtyl prenisolone
equivalent to 100mg of Prednisolone.
Idiopathic Rhinitis (Perennial nonallergic non-infectious Rhinitis)
It is more difficult to treat perennial Rhinitis than simple Hay fever.Short course oral C/S followed by
nasal C/S or Inj Methyl Prednisolone 80mg ( 1 amp I/m 4wkly for 3 Inj with nasal C/S.
Idiopathic Rhinitis have equal efficacy in patients with or without Eosinophilia (marked effect on
Eosinophilia.)
Rhinitis Medicamentosa
Withdrawal of oxymethazoline,
A short course of intra nasal C/S is recommended.
Inj Depot.
Infectious Rhinitis ( common Cold)
C/S are highly effective in Eosinophil dominated inflammation & allergy but not in neutrophil
dominated inflammation & infection. So not recommended in common cold.
Nasal polyposis
A short course systemic C/S + Nasal C/S
Severe Polyposis> Unsatisfactory,> Surgery+ C/S
Sinusitis
Intra nasal C/S are important in the treatment of sinusits>use remain controversial.
Angioedema
SystemicC/S +Epinephine +Antihistamine.
Adenoid
Lymphocyte are sensitive to C/S by mucillary clearance, anasal spray will be carried to the adenoidal
region,highly significant.
Epiglotitis
Dexamethasone indicated,
Tonsillectomy
A single Preoperative I/v Dexamethasone (.15-1mg/kg) can improve nausea/vomiting/pain.So
routine use of paediatric Tonsillectomy.

3. Croup
Is a frequent disease inchildren (hoarseness, a dry barking cough, inspired stridor. C/S is
sensitive( improved within 6hrs.) Dexamethasone (orally or 1/m). If available Nebulised Budesonide
can be used instead of.
Secretory otitis media
Not recommended now.
Sudden Deafness
Abrupt sensorneural hearing loss of at least 30db inat least 3contiguous audiometric frequencies
developing in 12hrs or less.(24hrs or less/3days or less.)
Labyrinthine blood circulation decrease
Subclinical viral labyrinthitis
Sponteous labyrinthine membrane rupture.
Autoimmune disease
Among Autoimmume & viral infection may be amrliorated by Steroid.
Meniere’s disease;
No C/S