What are steroids?
When ENT surgeons speak of steroids, we are generally referring to corticosteroids, which are produced naturally in the adrenal glands to help suppress bodily inflammation and cope with stress and anxiety. Cortisol and synthetic steroids such as prednisone reduce swelling, prevent the migration of white blood cells, and stabilize the membrane of cells that release inflammatory mediators. Other types of steroids include aldosterone, which is also produced in the adrenal gland and controls the balance of sodium and potassium in the body, and the sex steroids, which control secondary sex characteristics and reproduction. Anabolic steroids abused by athletes are a form of testosterone, a sex steroid.
Steroids are commonly used by otolaryngologists to treat:
- Nasal polyps
- Ear infections
- Sudden hearing loss
A short course of prednisone or methylprednisolone will almost certainly make you feel better. Steroids boost your energy level, alleviate pain and nausea, block allergies, reduce swelling, shrink nasal polyps, alleviate asthma, and can even restore hearing in some patients with sudden deafness. However, steroids must be used with caution, because they can have significant addictive potential and cause serious side effects – especially with long-term use. For this reason, oral or systemic steroids are reserved for the most urgent uses, and topical or local steroids are preferred.
Risks of Systemic Steroids
Steroids are the most effective anti-inflammatory drugs available, and are derivatives of natural hormones which the body creates to help the body cope with injury or stress. However, prolonged use of oral or systemic steroids can result in suppression of normal steroid levels in the body. Therefore, these medications should be taken exactly as prescribed, usually in a gradually decreasing dose, to avoid sudden withdrawal. Withdrawal symptoms are uncommon in patients who have used steroids for less than two weeks at a time. Continued or repeated use of steroids can reduce your ability to fight infection and can result in weight gain, fluid retention, acne, increased body hair, purple marks on the abdomen, collection of fatty deposits under the skin, and easy bruising. High doses of steroids will frequently cause nervousness, sleeplessness, excitation, and sometimes depression or confusion. Steroids can also cause elevation of blood sugar or blood pressure or change in salt balance. Prolonged steroids can cause thinning of the bones, muscle weakness, glaucoma, and cataracts. They can aggravate ulcers. Patients who are pregnant, have a history of stomach ulcers, glaucoma, diabetes, high blood pressure, tuberculosis, osteoporosis, or recent vaccination, should not take steroids unless absolutely necessary. A very rare complication of steroids is interruption of the blood supply to the hip bone which can result in a fracture that requires a hip replacement.
Fortunately, all of these complications are extremely rare in patients treated with short-term doses of steroids. If your doctor has prescribed systemic steroids, he or she has likely judged that the risk of these complications is outweighed by the potential benefit for the treatment of your disease. If you have any questions about this information or the instructions on how to take your steroids, please speak with your doctor before you begin the medication.
Alternatives to systemic steroids include topical applications to the nose, skin, lung or ear, so that the systemic dose – that which distributes through the body – is greatly reduced. Topical steroids greatly reduce the risk of prolonged use of steroids.