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Corticosteroid Confusion: Evidence lacking for most conditions, panelists say

by Mary Beth Nierengarten •

Overall, she said that the studies suggest that the use of topical nasal steroids—fluticasone proprionate and mometasone furoate—after FESS appears to be helpful in reducing recurrence of nasal polyps and decreasing longer-term symptoms from one to five years. However, she emphasized the diverse outcomes of the studies that make it difficult to definitively recommend the use of steroids in this setting. “I think many of us that do surgery, especially for our patients with polyps, are going to use oral steroids perioperatively to reduce bleeding,” she said. “But this is a field that is ripe for more investigation.”

Studies of Steroid Use and FESS

  • Dijkstra MD, Ebbens FA, Poublon RM, et al. Clin Exp Allergy. 2004;34(9):1395.
  • Rowe-Jones JM, Medcalf M, Durham SR, et al. Rhinology. 2005;43(1):2-10.
  • Ehnhage A, Ollson P, Kölbeck KG, et al. Allergy. 2009;64(5):762-769.
  • Stjärne P, Ollson P, Alenius M, et al. Arch Otolaryngol Head Neck Surg. 2009;135(3):296-302.
  • Jorissen M, Bachert C. Rhinology. 2009;47(3):280-286.

Bell’s Palsy, Meniere’s Disease, Sudden Hearing Loss

Lorne S. Parnes, MD, professor of otolaryngology and clinical neurological sciences at the University of Western Ontario in London, Ontario, summarized the evidence to date on the use of steroids in a number of conditions. For Bell’s palsy, he said the evidence is compelling and cited a 2010 Cochrane Review (Cochrane Database System Rev. 2010;3:DOI: 10.1002/14651858.CD001942.pub4) that supports the routine use of corticosteroids in the treatment of idiopathic facial paralysis.

Conversely, in Meniere’s disease, the evidence for steroid use is insufficient. “Meniere’s disease is a chronic condition, but most current steroid regimens are very short and limited, and that makes little logical sense to me,” he said, adding that the data for the efficacy of steroids using current regimens is unconvincing but may change with the development of different or better delivery methods.

Dr. Parnes cited evidence from a study (Otol Neurotol. 2011;32(3):393-397) that suggested that combination oral and systemic steroid treatment may be optimal for the problems associated with sudden hearing loss.

Overall, the presenters emphasized the need for more and stronger evidence on which to base the use of steroids in the treatment of many otolaryngologic conditions. ENT Today