Oral steroids are synthetic mimics of adrenal cortex hormones and are considered a staple in the management of chronic rhinosinusitis due to their anti-inflammatory effects. Despite their common use, many providers are not familiar with the potential risks of the drugs.
Methods
Literature review.
Results
An overview of the existing data on the risks of oral steroids is presented as well as a review of the malpractice lawsuits with regard to oral steroid use and a discussion of the data that support the use of oral steroids in patients with chronic rhinosinusitis with and those without nasal polyps.
Conclusion
It is essential for providers to be aware of the potential complications of a medication, the medical jurisprudence of the drugs, and the data that support their use.
Get full access to this article
View all access options for this article.
References
1.
DubinM.G.LiuC.LinS.Y. and SeniorB.A.American Rhinologic Society member survey on “maximal medical therapy” for chronic rhinosinusitis.Am J Rhinol21: 483–488, 2007.
2.
CopeD. and BovaR.Steroids in otolaryngology.Laryngoscope118: 1556–1560, 2008.
3.
PoetkerD.M. and RehD.D.A comprehensive review of the adverse effects of corticosteroids.Otolaryngol Clin North Am43: 753–768, 2010.
4.
FardetL.KassarA.CabaneJ. and FlahaultA.Corticosteroid-induced adverse events in adults.Drug Safety30: 861–881, 2007.
5.
FardetL.CabaneJ.LebbéC.Incidence and risk factors for corticosteroid-induced lipodystrophy: A prospective study.J Am Acad Dermatol57: 604–609, 2007.
6.
HirschI.B. and PaauwD.S.Diabetes management in special situations.Endocrinol Metab Clin North Am26: 631–645, 1997.
7.
ChrousosG.P.Adrenocorticosteroids and adrenocortical antagonists. In Basic and Clinical Pharmacology, 10th ed.KatzungB.G. (Ed). New York: McGraw-Hill, 635–652, 2007.
8.
SegalB.H. and SnellerM.C.Infectious complications of immunosuppressive therapy in patients with rheumatic diseases.Rheum Dis Clin North Am23: 219–237, 1997.
9.
ConnH.O. and PoynardT.Corticosteroids and peptic ulcer: Meta-analysis of adverse events during steroid therapy.J Intern Med236: 619–632, 1994.
10.
StuckA.E.MinderC.E. and FreyF.J.Risk of infectious complications in patients taking glucocorticosteroids.Rev Infect Dis11: 954–963, 1989.
11.
O'DonnellM.R.SchmidtG.M.TegtmeierB.R.Prediction of systemic fungal infection in allogeneic marrow recipients: Impact of amphotericin prophylaxis in high-risk patients.J Clin Oncol12: 827–834, 1994.
12.
FukudaT.BoeckhM.CarterR.A.Risks and outcomes of invasive fungal infections in recipients of allogeneic hematopoietic stem cell transplants after nonmyeloablative conditioning.Blood102: 827–833, 2003.
13.
LionakisM.S. and KontoyiannisD.P.Glucocorticoids and invasive fungal infections.Lancet362: 1828–1838, 2003.
14.
UptonA.KirbyK.A.CarpenterP.Invasive aspergillosis following hematopoietic cell transplantation: Outcomes and prognostic factors associated with mortality.Clin Infect Dis44: 531–540, 2007.
15.
MarrK.A.CarterR.A.BoeckhM.Invasive aspergillosis in allogeneic stem cell transplant recipients: Changes in epidemiology and risk factors.Blood100: 4358–4366, 2002.
16.
AtkinsonJ.B.KosiM.SrikanthM.S.Growth hormone reverses impaired wound healing in protein-malnourished rats treated with corticosteroids.J Pediatr Surg27: 1026–1028, 1992.
17.
NguyenH.LimJ.DresnerM.L. and NixonB.Effect of local corticosteroids on early inflammatory function in surgical wound of rats.J Foot Ankle Surg37: 313–318, 1998.
18.
GoforthP. and GudasC.J.Effects of steroids on wound healing: A review of the literature.J Foot Surg19: 22–28, 1980.
19.
SuhD.Y.HuntT.K. and SpencerE.M.Insulin-like growth factor-I reverses the impairment of wound healing induced by corticosteroids in rats.Endocrinology131: 2399–2403, 1992.
20.
LencoW.McKnightM. and MacDonaldA.S.Effects of cortisone acetate, methylprednisolone and medroxyprogesterone on wound contracture and epithelialization in rabbits.Ann Surg181: 67–73, 1975.
21.
KeenanG.F.Management of complications of glucocorticoid therapy.Clin Chest Med18: 507–520, 1997.
22.
AllenD.B.BieloryL.DerendorfH.Inhaled corticosteroids: Past lessons and future issues.J Allergy Clin Immunol112(suppl.): S1–S40, 2003.
23.
TonF.N.GunawardeneS.C.LeeH. and NeerR.M.Effects of low dose prednisone on bone metabolism.J Bone Miner Res20: 464–470, 2005.
24.
van StaaT.P.LeufkensH.G. and CooperC.The epidemiology of corticosteroid-induced osteoporosis: A meta-analysis.Osteoporos Int13: 777–787, 2002.
25.
CuiQ.WangG-J, and BalianG.Steroid-induced adipogenesis in a pluripotential cell line from bone marrow.J Bone Joint Surg Am79: 1054–1063, 1997.
26.
MirzaiR.ChangC.GreenspanA. and GershwinM.E.The pathogenesis of osteonecrosis and the relationship to corticosteroids.J Asthma36: 77–95, 1999.
27.
McKeeM.D.WaddellJ.P.KudoP.A.Osteonecrosis of the femoral head in men following short-course corticosteroid therapy: A report of 15 cases.CMAJ164: 205–206, 2001.
28.
WongG.K.PoonW.S. and ChiuK.H.Steroid-induced avascular necrosis of the hip in neurosurgical patients: Epidemiological study.ANZ J Surg75: 409–410, 2005.
29.
CarnahanM.C. and GoldsteinD.A.Ocular complications of topical, periocular, and systemic corticosteroids.Curr Opin Ophthalmol11: 478–483, 2000.
30.
PiperJ.M.RayW.A.DaughertyJ.R.Corticosteroid use and peptic ulcer disease: Role of nonsteroidal anti-inflammatory drugs.Ann Intern Med114: 735–740, 1991.
31.
AsareK.Diagnosis and treatment of adrenal insufficiency in the critically ill patient.Pharmacotherapy27: 1512–1528, 2007.
32.
GanongW.F.The adrenalmedulla and adrenal cortex. In Review of Medical Physiology, 22nd ed.GanongW.F. (Ed). New York: McGraw-Hill, 356–381, 2007.
33.
DownieW.W.DixonJ.S.LoweJ.R.Adrenocortical suppression by synthetic corticosteroid drugs: A comparative study of prednisolone and betamethasone.Br J Clin Pharmacol6: 397–399, 1978.
34.
WilsonA.M.McFarlaneL.C. and LipworthB.J.Systemic bioactivity profiles of oral prednisolone and nebulized budesonide in adult asthmatics.Chest114: 1022–1027, 1998.
35.
LaRochelleG.E.Jr., LaRochelleA.G.RatnerR.E. and BorensteinD.G.Recovery of the hypothalamic-pituitary-adrenal (HPA) axis in patients with rheumatic diseases receiving low-dose prednisone.Am J Med95: 258–264, 1993.
36.
WarringtonT.P. and BostwickJ.M.Psychiatric adverse effects of corticosteroids.Mayo Clin Proc81: 1361–1367, 2006.
37.
LewisD.A. and SmithR.E.Steroid-induced psychiatric syndromes.J Affect Disord5: 319–332, 1983.
38.
Acute adverse reactions to prednisone in relation to dosage.Clin Pharmacol Ther13: 694–698, 1972.
39.
KershnerP. and Wang-ChengR.Psychiatric side effects of steroid therapy.Psychosomatics30: 135–139, 1989.
40.
FinkJLIII. Liability claims based on drug use.Drug Intell Clin Pharm17: 667–670, 1983.
41.
CraneM.The medication errors that get doctors sued.Med Econ70: 36–38, 40–41, 1993.
42.
RothschildJ.M.FedericoF.A.GandhiT.K.Analysis of medication-related malpractice claims.Arch Intern Med162: 2414–2420, 2002.
43.
NashJ.J.NashA.G.LeachM.E. and PoetkerD.M.Medical malpractice and corticosteroid use.Otolaryngol Head Neck Surg144: 10–15, 2011.
44.
PoetkerD.M. and SmithT.L.What rhinologists and allergists should know about the medico-legal implications of corticosteroid use: A review of the literature.Int Forum Allergy Rhinol2: 95–103, 2012.
45.
PoetkerD.M.JakubowskiL.A.LalD.Oral corticosteroids in the management of adult chronic rhinosinusitis with and without nasal polyps: An evidence-based review with recommendations.Int Forum Allergy Rhinol3: 104–120, 2013.
46.
LalD.SciannaJ.M. and StankiewiczJ.A.Efficacy of targeted medical therapy in chronic rhinosinusitis, and predictors of failure.Am J Rhinol Allergy23: 396–400, 2009.
47.
SubramanianH.N.SchechtmanK.B.HamilosD.L.A retrospective analysis of treatment outcomes and time to relapse after intensive medical treatment for chronic sinusitis.Am J Rhinol16: 303–312, 2002.
48.
HesslerJ.L.PiccirilloJ.F.FangD.Clinical outcomes of chronic rhinosinusitis in response to medical therapy: Results of a prospective study.Am J Rhinol21: 10–18, 2007.
49.
IkedaK.SakuradaT.SuzakiY. and TakasakaT.Efficacy of systemic corticosteroid treatment for anosmia with nasal and paranasal sinus disease.Rhinology33: 162–165, 1995.
50.
JankowskiR. and BodinoC.Olfaction in patients with nasal polyposis: Effects of systemic steroids and radical ethmoidectomy with middle turbinate resection (nasalization).Rhinology41: 220–230, 2003.
51.
JankowskiR. and BodinoC.Evolution of symptoms associated to nasal polyposis following oral steroid treatment and nasalization of the ethmoid-radical ethmoidectomy is functional surgery for NPS.Rhinology41: 211–219, 2003.
52.
VaidyanathanS.WilliamsonP.AndersonK. and LipworthB.Effect of systemic steroids on humming nasal nitric oxide in chronic rhinosinusitis with nasal polyposis.Ann Allergy Asthma Immunol105: 412–417, 2010.
53.
LandsbergR.SegevY.DeRoweA.Systemic corticosteroids for allergic fungal rhinosinusitis and chronic rhinosinusitis with nasal polyposis: A comparative study.Otolaryngol Head Neck Surg136: 252–257, 2007.
54.
DammM.JungehulsingM.EckelH.E.Effects of systemic steroid treatment in chronic polypoid rhinosinusitis evaluated with magnetic resonance imaging.Otolaryngol Head Neck Surg120: 517–523, 1999.
55.
van CampC. and ClementP.A.Results of oral steroid treatment in nasal polyposis.Rhinology32: 5–9, 1994.
56.
TuncerU.SoyluL.AydoganB.The effectiveness of steroid treatment in nasal polyposis.Auris Nasus Larynx30: 263–268, 2003.
57.
RaspG.KramerM.F.OstertagP. and KastenbauerE.A new system for the classification of ethmoid polyposis. Effect of combined local and systemic steroid therapy.Laryngorhinootologie79: 266–272, 2000.
58.
BlomqvistE.H.LundbladL.AnggardA.A randomized controlled study evaluating medical treatment versus surgical treatment in addition to medical treatment of nasal polyposis.J Allergy Clin Immunol107: 224–228, 2001.
59.
BenitezP.AlobidI.de HaroJ.A short course of oral prednisone followed by intranasal budesonide is an effective treatment of severe nasal polyps.Laryngoscope116: 770–775, 2006.
60.
AlobidI.BenitezP.PujolsL.Severe nasal polyposis and its impact on quality of life. The effect of a short course of oral steroids followed by long-term intranasal steroid treatment.Rhinology44: 813, 2006.
61.
KroflicB.CoerA.BaudoinT. and KalogjeraL.Topical furosemide versus oral steroid in preoperative management of nasal polyposis.Eur Arch Otorhinolaryngol263: 767–771, 2006.
62.
Van ZeleT.GevaertP.HoltappelsG.Oral steroids and doxycycline: Two different approaches to treat nasal polyps.J Allergy Clin Immunol125: 1069–1076, 2010.
63.
HissariaP.SmithW.WormaldP.J.Short course of systemic corticosteroids in sinonasal polyposis: A double-blind, randomized, placebo-controlled trial with evaluation of outcome measures.J Allergy Clin Immunol118: 128–133, 2006.
64.
VaidyanathanS.BarnesM.WilliamsonP.Treatment of chronic rhinosinusitis with nasal polyposis with oral steroids followed by topical steroids: A randomized trial.Ann Intern Med154: 293–302, 2011.
65.
KirtsreesakulV.WongsritrangK.RuttanapholS.Clinical efficacy of a short course of systemic steroids in nasal polyposis.Rhinology49: 525–532, 2011.
66.
SieskiewiczA.OlszewskaE.RogowskiM. and GryczE.Preoperative corticosteroid oral therapy and intraoperative bleeding during functional endoscopic sinus surgery in patients with severe nasal polyposis: A preliminary investigation.Ann Otol Rhinol Laryngol115: 490–494, 2006.
67.
WrightE.D. and AgrawalS.Impact of perioperative systemic steroids on surgical outcomes in patients with chronic rhinosinusitis with polyposis: Evaluation with the novel perioperative sinus endoscopy (POSE) scoring system.Laryngoscope117(suppl 115): 1–28, 2007.
68.
GiordanoJ.DarrasJ.ChevalierD. and MortuaireG.Preoperative corticosteroid treatment and nasal polyposis.Ann Otolaryngol Chir Cervicofac126: 120–124, 2009.
69.
OcampoC.J. and PetersA.T.Medical therapy as the primary modality for the management of chronic rhinosinusitis.Allergy Asthma Proc34: 132–137, 2013.
70.
RamakrishnanV.R.KingdomT.T.NayakJ.V.Nationwide incidence of major complications in endoscopic sinus surgery.Int Forum Allergy Rhinol2: 34–39, 2012.
71.
PoetkerD.M. and SmithT.L.What rhinologists and allergists should know about the medico-legal implications of antibiotic use: A review of the literature.Int Forum Allergy Rhinol5: 104–110, 2015.
