Published on October 31, 2018
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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