Oral Steroids for Nasal and Tonsil Swelling

Tonsil Swelling

• The American Academy of Otolaryngology-Head and Neck Surgery recommends administering a single intraoperative dose of intravenous dexamethasone (0.5 mg/kg) to decrease postoperative nausea/vomiting, throat pain, and time to resumption of oral intake in children undergoing tonsillectomy, based on a strong recommendation from randomized controlled trials and systematic reviews 1
• The mechanism of dexamethasone efficacy is likely related to anti-inflammatory properties that reduce pain and swelling, with benefits including decreased incidence of postoperative nausea/vomiting, decreased times to first oral intake, and decreased pain as measured by lower pain scores 1
• Patients with endocrine disorders already receiving exogenous steroids or those in whom steroid administration may interfere with normal glucose-insulin regulation (e.g., diabetics) should be excluded from receiving dexamethasone 1

Nasal Swelling (Rhinitis and Rhinosinusitis)

• The Journal of Allergy and Clinical Immunology suggests that a short course (5-7 days) of oral corticosteroids may be appropriate for very severe nasal symptoms in allergic rhinitis, but intranasal corticosteroids remain the first-line treatment and oral steroids should be reserved for exceptional cases 2
• For chronic rhinosinusitis with nasal polyps (CRSwNP), short courses of oral corticosteroids (7-21 days) combined with intranasal corticosteroids result in significant reduction in total symptom score and nasal polyp score, according to Rhinology 3
• The beneficial effects of oral corticosteroids are maintained by subsequent administration of maintenance intranasal corticosteroids, as stated by the Journal of Allergy and Clinical Immunology 4
• Oral corticosteroids should NOT be administered as therapy for chronic rhinitis except for rare patients with severe intractable nasal symptoms unresponsive to other treatments, according to Praxis Medical Insights 5
• Long-term or repeated parenteral corticosteroids are contraindicated due to the greater potential for long-term adverse effects, as warned by the Journal of Allergy and Clinical Immunology and Praxis Medical Insights 2, 5
• Rare but serious side effects of oral corticosteroids include avascular necrosis and fatal varicella-zoster in immunocompetent patients, as reported by Rhinology 3
• Intranasal corticosteroids are the most effective monotherapy for nasal swelling from allergic rhinitis or chronic rhinosinusitis, and should be used as first-line treatment, according to the Journal of Allergy and Clinical Immunology and Praxis Medical Insights 2, 5, 6