Steroids and their use in ENT Get in touch with us at: www.facebook.com/drraiammar www.twitter.com/drraiammar www.instagram.com/drraiammar www.linkedin.com/in/drraiammar www.themedicall.com/blog/auther/drraiammar/ For Any Book or Notes Visit Our Website: www.allmedicaldata.wordpress.com www.drraiammar.blogspot.com YouTube Channel : https://www.youtube.com/channel/UCu-oR9V3OdFNTJW5yqXWXxA BY: DR RAI M. AMMAR MADNI

1. DR RAI M. AMMAR MADNI
H. SURGEON ENT Unit II
MAYO HOSPITAL, LAHORE

2. DR RAI M. AMMAR MADNI
H. SURGEON ENT Unit II
MAYO HOSPITAL, LAHORE

3.  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

4. Adernal cortex:
Synthesizes two classes of steroids
 Androgen (19 carbon atoms)
 Corticosteriods (21 carbon atoms)
-Mineralocorticoids (Electrolyte balance regulating)
-Glucocorticoids (Carbohydrate metabolism regulating)
-Hydrocortisone (cortisol) Aldosterone

5. steroids possess a common structure
PERHYDROCYCLOPENTANOPHENANTHRENE
NUCLEUS (RPS) & includes
 cholesterol
 bile acids
 androgens
 adrenocortical
 adrenomedullary
 estrogenic
 progestational hormones

6.  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.

7.  Intravenous (IV)
 Oral (PO)
 Intramuscular (IM)
 Intranasal (IN)
 Ear drops

8.  Intravenous (IV)
Methylprednisolone / Dexamethasone are preferred as intravenous steroids.
 Oral (PO)
Oral is preferred for long terrm administration.
Dexamethasone is the most potent oral steroid with very negligible mineralocorticoid
effect.
 Intramuscular (IM)
Methyl prednisolone acetate is commonly used.

9.  Intranasal (IN)
Intranasally administered steroid should be
lipophilic First pass metabolism is avoided Very low
dose is enough for local effect – reduced systemic
toxicity.
Fluticasone propionate commonly used.
Allergic rhinitis, Vasomotor rhinitis, Nasal polyposis,
Management of rhinitis medicamentosa, Idiopathic
rhinitis
 Ear drops
Used to treat eczematous conditions of the skin
lining of external canal, Myringitis granulosa, to
reduce middle ear mucosal oedema in active middle
ear infections with central perforation.

10. Systemic steroids indications concerning with
the ENT Department includes,
 Acute allergic rhinitis
 acute sinusitis
 Acute sensorineural hearing loss (sudden
deafness)
 Acute stridor before tracheostomy
 Acute epiglottitis

11.  Nasal sarcoidosis
 sinonasal inflammatory polyposis
 Otitis externa – to reduce external canal inflammatory
oedema
 management of idiopathic facial nerve palsy.
 croup.

12. The therapeutic efficacy of steroids in the management
of following still remains controversial:
 Meniere's disease
 sudden idiopathic sensorineural HL
 chronic otitis media
 vestibular neuronitis

13. Complications Associated with
 Short-term Use of Steroids
 Long-term Use of Steroids

14.  Hypothalamic-pituitary-adrenal axis suppression
 Hyperglycemia
 Gastrointestinal Disturbances
 Psychiatric effects

15.  Osteoporosis
 Cushingnoid appearance
 Accelerated atherosclerosis
 early cataract
 skin thinning
 Pupura

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 www.instagram.com/drraiammar
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For Any Book or Notes Visit Our Website:
 www.allmedicaldata.wordpress.com
 www.drraiammar.blogspot.com
YouTube Channel :
 https://www.youtube.com/channel/UCu-oR9V3OdFNTJW5yqXWXxA
BY:
DR RAI M. AMMAR MADNI