Corticosteroid Use in Otolaryngology: Current Considerations During the COVID‐19 Era

Abstract

Objective To offer pragmatic, evidence-informed advice on administering corticosteroids in otolaryngology during the coronavirus disease 2019 (COVID-19) pandemic, considering therapeutic efficacy, potential adverse effects, susceptibility to COVID-19, and potential effects on efficacy of vaccination against SARS-CoV-2, which causes COVID-19. Data Sources PubMed, Cochrane Library, EMBASE, CINAHL, and guideline databases. Review Methods Guideline search strategies, supplemented by database searches on sudden sensorineural hearing loss (SSNHL), idiopathic facial nerve paralysis (Bell’s palsy), sinonasal polyposis, laryngotracheal disorders, head and neck oncology, and pediatric otolaryngology, prioritizing systematic reviews, randomized controlled trials, and COVID-19–specific findings. Conclusions Systemic corticosteroids (SCSs) reduce long-term morbidity in individuals with SSNHL and Bell’s palsy, reduce acute laryngotracheal edema, and have benefit in perioperative management for some procedures. Topical or locally injected corticosteroids are preferable for most other otolaryngologic indications. SCSs have not shown long-term benefit for sinonasal disorders. SCSs are not a contraindication to vaccination with COVID-19 vaccines approved by the US Food and Drug Administration. The Centers for Disease Control and Prevention noted that these vaccines are safe for immunocompromised patients. Implications for Practice SCS use for SSNHL, Bell’s palsy, laryngotracheal edema, and perioperative care should follow prepandemic standards. Local or topical corticosteroids are preferable for most other otolaryngologic indications. Whether SCSs attenuate response to vaccination against COVID-19 or increase susceptibility to SARS-CoV-2 infection is unknown. Immunosuppression may lower vaccine efficacy, so immunocompromised patients should adhere to recommended infection control practices. COVID-19 vaccination with Pfizer-BioNTech, Moderna, or Johnson & Johnson vaccines is safe for immunocompromised patients.

Acute Unilateral Peripheral Vestibulopathy After COVID-19 Vaccination: Initial Experience in a Tertiary Neurotology Center

“…Six of eight patients in the present study received systemic steroids in the acute phase of the disease. In retrosptect, this treatment must be re-evaluated critically regarding a potential attenuation of the vaccine-induced immune response against SARS-CoV-2 (12,75,76). When the patients presented with acute vestibular symptoms, they usually did not mention that they had received a recent COVID-19 vaccination, and the question about vaccination status was not part of our clinical routine before this study.…”

“…Consulting an immunologist or infectious disease specialist is useful in this context. As described for SSNHL after COVID-19 vaccinations before (9,12,75), intratympanic application of steroids into the affected ear is also an alternative (17).…”

Sudden Sensorineural Hearing Loss after Third Dose Booster of COVID-19 Vaccine Administration

“…The treatment of SSHL after COVID-19 vaccination is the same as in the absence of the vaccine. Good clinical practice guidelines indicated that corticosteroids can be administered within two weeks as initial therapy for SSHL [ 14 ]. Corticosteroids, immunosuppressive agents, or diseases of vaccine recipients can affect the antibody response to the vaccination.…”

“…Although this treatment protocol modifies the classic one (three administration in one week), our clinical experience in the treatment of post COVID-19 hearing loss supported us in using this therapy with good results. If a systemic high dose of steroid was administered during the vaccination period, a measurement of the antibody titer could be necessary after completion of the vaccination [ 14 ].…”

Cricotracheostomy for patients with severe COVID-19: A case control study

“…Systemic corticosteroid is recommended in patients with severe COVID-19 ( 37 ), and almost all patients with severe COVID-19 in this cohort were administered systemic corticosteroid. Although it is still unknown whether systemic steroid influences the stomal granulation ( 38 ), the lower rate of stomal granulation might be influenced by systemic corticosteroid. In addition, the decannulation rate was significantly lower in the control group.…”