Oral corticosteroid prescribing habits of Canadian Otolaryngologist-Head and Neck Surgeons

Abstract

BackgroundOral corticosteroids (OCSs) are widely prescribed in Otolaryngology-Head & Neck surgery (OtoHNS). There is evidence in the literature regarding specific dosing regimens. However, it is not known to what extent these recommendations are being implemented in practice.MethodsAn anonymous online survey was sent to Canadian Society of Otolaryngology-Head and Neck Surgery members (N = 696). Dosing, frequency and tapering of OCSs were assessed in acute rhino-sinusitis (ARS), chronic rhino-sinusitis with (CRSwP) and without polyps (CRSsP), sudden sensori-neural hearing loss (SSNHL), and idiopathic facial nerve/Bell’s palsy (IFN). Participants were asked to complete for conditions treated and results were compared with current guidelines. Development of prescribing habits and observed complications were also explored.Results124 surveys (18 %) were completed. In CRSwP (N = 98), the median dose was 50 mg (Range: 10–100 mg) and the average duration was 8 days (Range: 1–21 days). In CRSsP (N = 29), the median dose was 50 mg (Range: 20-80 mg) and the average duration was 8 days (Range: 1–14 days). In SSNHL (N = 118), the median dose was 60 mg (Range: 10–120 mg) and the average duration was 10 days (Range: 1–21 days). In IFN (N = 108), the median dose was 50 mg (Range: 10–100 mg) and the average duration was 10 days (Range: 1–21 days). Tapering dosages were used in treating CRSwP (64 %), CRSsP (62 %), ARS (44 %), SSNHL (60 %) and IFN (53 %). Respondents most frequently perceived “Mentor/Preceptor Guidance” as a source of their prescribing habits.ConclusionThere is significant heterogeneity in OCS prescribing habits despite the availability of fairly consistent evidence in the literature for some of the surveyed conditions. Improvements in standardization should be made with the aim of enhancing outcomes and reducing complications.

Perioperative practices in thyroid surgery: An international survey

“…The overall response rate of 23% is comparable, if not superior, to several other peer‐reviewed head and neck themed surveys (range, 7.9% to 19%) . Furthermore, our response rate does not significantly differ from the recently published survey on the identification of the external branch of the superior laryngeal nerve in thyroid surgery, a survey that was exclusively sent to thyroid surgeons, as opposed to more general medical associations.…”

Inpatient treatment of patients with acute idiopathic peripheral facial palsy: A population‐based healthcare research study

“…There are only two recent studies published directly related to healthcare questions concerning the treatment of IFP, a survey and a population‐based study . The former survey performed in 2014 revealed that 87% of Canadian otolaryngologists prescribe prednisolone in for IFP in a dose range of 10‐100 mg per day for IFP over 1 to 21 days .…”

“…There are only two recent studies published directly related to healthcare questions concerning the treatment of IFP, a survey and a population‐based study . The former survey performed in 2014 revealed that 87% of Canadian otolaryngologists prescribe prednisolone in for IFP in a dose range of 10‐100 mg per day for IFP over 1 to 21 days . After publication of the Scottish Bell's palsy study in 2007, the proportion of patients treated with prednisolone only increased to about 35%, combined corticosteroid and antiviral treatment decreased to about 20%, antiviral therapy only was used in about 5%, but the proportion of untreated patients remained constant until 2012 with about 40% to 44% .…”

“…In the UK, the publication of the Scottish Bell's palsy study was clearly associated with a change in management by general practices, the rate of prednisolone therapies increased, the rate of combination therapies with antiviral drugs decreased, but still 44% of the cases remained untreated. Recently, a survey with Canadian otolaryngologist and head and neck surgeons revealed significant heterogeneity in corticosteroid prescribing habits for IFP (daily dose of 10‐100 mg corticosteroids for a duration of 1‐21 days) despite the availability of clear guidelines for dosing regimens and duration …”

“…Recently, a survey with Canadian otolaryngologist and head and neck surgeons revealed significant heterogeneity in corticosteroid prescribing habits for IFP (daily dose of 10-100 mg corticosteroids for a duration of 1-21 days) despite the availability of clear guidelines for dosing regimens and duration. 11 In this respect, it was reasonable to analyse the guideline adherence also in Germany. Thuringia is a territorial state in Germany with approximately 2.2 million habitants.…”