Systemic Steroids for Otolaryngology–Head and Neck Surgery Disorders: An Evidence‐Based Primer for Clinicians

Abstract

Objective To offer pragmatic, evidence-informed guidance on the use of systemic corticosteroids (SCS) for common otolaryngologic disorders. Data Sources PubMed, Cochrane Library, and American Academy of Otolaryngology–Head and Neck Surgery Foundation clinical practice guidelines. Review Methods A comprehensive search of published literature through November 2021 was conducted on the efficacy of SCS, alone or in combination with other treatments, for managing disorders in otolaryngology and the subdisciplines. Clinical practice guidelines, systematic reviews, and randomized controlled trials, when available, were preferentially retrieved. Interventions and outcomes of SCS use were compiled to generate summary tables and narrative synthesis of findings. Conclusions Evidence on the effectiveness of SCS varies widely across otolaryngology disorders. High-level evidence supports SCS use for Bell’s palsy, sinonasal polyposis, and lower airway disease. Conversely, evidence is weak or absent for upper respiratory tract infection, eustachian tube dysfunction, benign paroxysmal positional vertigo, adenotonsillar hypertrophy, or nonallergic rhinitis. Evidence is indeterminate for acute laryngitis, acute pharyngitis, acute sinusitis, angioedema, chronic rhinosinusitis without polyps, Ménière’s disease, postviral olfactory loss, postoperative nerve paresis/paralysis, facial pain, and sudden sensorineural hearing loss. Implications for Practice Clinicians should bring an evidence-informed lens to SCS prescribing to best counsel patients regarding the risks, anticipated benefits, and limited data on long-term effects. Alternate routes of corticosteroid administration—such as sprays, drops, inhalers, and intralesional injections—may be preferable for many disorders, particularly those that are self-limited or require a prolonged duration of therapy. Prudent use of SCS reduces the risk of medication-related adverse effects. Clinicians who are conversant with high-level evidence can achieve optimal outcomes and stewardship when prescribing SCS.

Management, Referral Patterns, and Outcomes in Bell's Palsy: A Single‐Institution 903 Patient Series

“…3,14 Although systemic corticosteroid therapy is indicated for a wide range of common otolaryngologic disorders, careful consideration must be given to the potential adverse effects and prudent use and stewardship is needed. 15 In the acute setting, the AAO-HNS clinical practice guideline for the management of BP strongly recommends the use of high-dose corticosteroids, ideally initiated within 72 hours, to promote spontaneous recovery. 4 In our study cohort, 88.7% of all patients were treated with steroids; however, steroid therapy varied, with 77.3% receiving inadequate therapy, ranging from a one-time intravenous or oral dose to insufficient dosage or duration of oral regimen.…”

“…Randomized controlled trials have demonstrated a significantly increased likelihood of recovery and decreased time to recovery in patients treated with steroids compared to placebo 3,14 . Although systemic corticosteroid therapy is indicated for a wide range of common otolaryngologic disorders, careful consideration must be given to the potential adverse effects and prudent use and stewardship is needed 15 . In the acute setting, the AAO‐HNS clinical practice guideline for the management of BP strongly recommends the use of high‐dose corticosteroids, ideally initiated within 72 hours, to promote spontaneous recovery 4 .…”

Migraine management for the otolaryngologist

“…Other medications used for acute migrainous vertigo include those routinely used for acute vertigo from other causes. Despite inconclusive evidence detailed in McCoul et al, 65 systemic corticosteroids have been broadly used in acute vestibular neuritis and sudden sensorineural hearing loss 65 . Based on a 65‐year systematic review, corticosteroids are as effective as migraine abortive medications for acute attacks 66 .…”

“…Despite inconclusive evidence detailed in McCoul et al, 65 systemic corticosteroids have been broadly used in acute vestibular neuritis and sudden sensorineural hearing loss. 65 Based on a 65‐year systematic review, corticosteroids are as effective as migraine abortive medications for acute attacks. 66 Prakash and Shah detail improvement of migrainous vertigo after intravenous methylprednisolone administration in acute and chronic vertigo recalcitrant to other medications.…”

A teljes körű kivizsgálás eredményei fülzúgásban szenvedőkön

“…A nemzetközi irányelvek a halláscsökkenéshez társult fülzúgást az elsődleges tinnituscsoportba sorolják [22]. A halláscsökkenés jelenléte különösen lényeges az akut esetekben, ilyenkor az intravénás szteroidkezelés megkezdése evidenciaszinten szükséges [29]. Emellett a krónikus halláscsökkenés javítása is csökkentheti a fülzúgás súlyosságát, például hallókészülék vagy hallásjavító műtét segítségével [30].…”