As of Wednesday, June 12, 2013
DEAR DOCTOR K: I have chronic sinusitis and nasal polyps. My specialist suggested trying oral corticosteroids. What do you think?
DEAR READER: “Steroids” is short for anti-inflammatory hormones called corticosteroids, and “oral” means steroids taken in pill form. I think a short course of five to seven days of oral steroids is worth a try. That’s particularly true if your sinusitis isn’t getting any better. My colleague, Neil Bhattacharyya, an ear, nose and throat doctor and professor at Harvard Medical School, agrees. Much of what I say below is based on his advice.
As you know, sinusitis is an inflammation of the mucous membranes that line the sinuses. It often causes headaches and an uncomfortable feeling of pressure in the face.
Chronic inflammation in the membranes of your nose and sinuses can cause fleshy growths called polyps. Not all cases of chronic sinusitis result in polyps, but when they form, polyps can block your nasal passages and sinuses. This makes breathing more difficult and can diminish your sense of smell. Polyps also make it easier for infections to start in your sinuses. (I’ve put an illustration of polyps on my website, AskDoctorK.com.)
I assume you’ve tried the usual techniques for dealing with sinusitis: inhaling steam, taking extra-long showers, drinking lots of water and sleeping with your head elevated. A course of antibiotics is also often appropriate if there are clear signs of bacterial infection in your sinuses (such as green or brown discharge when you blow your nose, a fever and a rotten feeling).
Once sinusitis becomes chronic, the inflammation can take on a life of its own. Corticosteroids become an important treatment option, as they have anti-inflammatory effects.
The first type of steroid to try is one that can be inhaled into the nose. Inhaled steroids deliver the medicine directly to the inflamed tissues that need to be quieted. However, polyps can block the passage of the inhaled steroids to some of the inflamed areas.
If inhaled steroids don’t do the job, it’s worth considering a brief course of steroids in pill form. Taking an oral steroid such as prednisone for a week or so reduces the size of the polyps a little and decreases overall inflammation in the nose. Shrinking polyps and reducing inflammation allow the topical steroid to reach its target and be more effective.
The reason I and many doctors hold off on using steroids in pill form is that the medicine travels in the blood, exposing the whole body to the medication. (In contrast, topical steroids expose only the nose and sinuses.) Side effects are more likely from oral steroids than from inhaled steroids; they may include elevated pressure in the eyes (glaucoma), increased blood pressure and mood swings. But in my experience, a short course of oral steroids, such as what I’m recommending here, rarely produces serious side effects.
Dr. Anthony L. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.