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The Use of Systemic Steroids in Otolaryngology

Introduction Glucocorticoids act throughout the body to regulate metaboli sm and protect the organism under stre ss. Otolaryngologists use systemic steroids to suppress inflammation and limit neural injury. Short-term administration rarely produces harmful side effects. With prolonged use, these metabolic effects produce Cushing' s syndrome. Other potential side effects include reactivation of infection, diabetes, osteoporosis, peptic ulcer, hypertension, psychological changes, myopathy, cataracts, impaired wound healing and avascular necrosis. To avoid or minimize these complications, long-term steroid therapy can be administered as a single morning dose every other day. Further guidelines for prescribing systemic steroids will be explored, and the role of these drugs in treating sinonasal disease, Bell' s palsy, sudden idiopathic hearing loss, autoimmune inner ear disease, airway edema, posttonsillectomy pain, caustic ingestion and bacterial meningitis will be discussed. Otolaryngologists use steroids in a wide variety of .clinical situations. While most, if not all, physicians respect steroids as potentially dangerous medicat ions, having an in-depth knowledge of the specific risks and potential benefits of steroid therapy will lead to optimal patient outcomes. This paper will review the basic physiology and possible side effects of systemic glucocorticoids, followed by practical guidelines for their use.