Corticosteroids (Prednisone) in Chronic Rhinosinusitis (CRS)

A blister pack and box of Prednisone 10 mg tablets, showing white round pills partially pulled out from the packaging labeled "50 tablets"

 What is Chronic Rhinosinusitis (CRS)?

Chronic rhinosinusitis (CRS) is a condition where the sinuses (air-filled spaces in your face) stay inflamed or swollen for more than 12 weeks. It can cause:

• A blocked or stuffy nose

• Thick mucus or nasal discharge

• Pain or pressure in the face

• Loss of smell (Mayo Clinic, 2019)
  

Sometimes, it’s linked with nasal polyps, which are soft, noncancerous growths inside the nose (Fokkens et al., 2020).

What are corticosteroids?

Corticosteroids are anti-inflammatory medications that help reduce swelling in the body(Hodgens & Sharman, 2023). One of the most used corticosteroids is prednisone, which can be taken as a pill.

How does prednisone help in CRS?

In people with severe CRS, especially if they have nasal polyps, prednisone can:

• Shrink the polyps

• Improve breathing

• Relieve sinus pressure and facial pain

• Restore the sense of smell (Haxel et al., 2015)

Prednisone is usually prescribed as a short course (often 5 to 14 days) to reduce inflammation quickly when other treatments (like nasal sprays) are not enough.

Are there risks or side effects?

Prednisone can cause side effects, especially if used for a long time or at high doses. (Yasir et al., 2023) These include:

• Mood changes or trouble sleeping

• Increased appetite or weight gain

• High blood sugar

• Risk of infection

• Bone weakening if used long-term

Because of these risks, doctors try to limit its use to short periods when symptoms are severe (Fokkens et al., 2020; Rosenfeld et al., 2015).

Other options for CRS

Prednisone is usually part of a larger treatment plan, which may also include:

• Saline rinses to clean the sinuses

• Nasal steroid sprays for daily control

• Allergy treatment if allergies are part of the problem

• Surgery (like endoscopic sinus surgery) if medications don’t help

When should you talk to your doctor?

If you have long-term sinus symptoms that don’t improve with over-the-counter treatments, see a doctor especially an ENT (ear, nose, and throat specialist). Prednisone may be helpful for short-term relief, but it’s not a cure and should be used carefully.

References

Fokkens, W. J., Lund, V. J., Hopkins, C., Hellings, P. W., Kern, R., Reitsma, S., Toppila-Salmi, S., Bernal-Sprekelsen, M., Mullol, J., Alobid, I., Terezinha Anselmo-Lima, W., Bachert, C., Baroody, F., von Buchwald, C., Cervin, A., Cohen, N., Constantinidis, J., De Gabory, L., Desrosiers, M., & Diamant, Z. (2020). European Position Paper on Rhinosinusitis and Nasal Polyps 2020. Rhinology Journal, 0(0), 1–464. https://doi.org/10.4193/rhin20.600

Head, K., Lee Yee Chong, Hopkins, C., Philpott, C., Schilder, A. G. M., & Burton, M. J. (2016). Short-course oral steroids as an adjunct therapy for chronic rhinosinusitis. 2016(4). https://doi.org/10.1002/14651858.cd011992.pub2

Hodgens, A., & Sharman, T. (2023, May 1). Corticosteroids. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK554612/

Mayo Clinic. (2019). Nasal polyps - Symptoms and causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/nasal-polyps/symptoms-causes/syc-20351888

Rosenfeld, R. M., Piccirillo, J. F., Chandrasekhar, S. S., Brook, I., Ashok Kumar, K., Kramper, M., Orlandi, R. R., Palmer, J. N., Patel, Z. M., Peters, A., Walsh, S. A., & Corrigan, M. D. (2020). Clinical practice guideline (update): Adult sinusitis. Otolaryngology–Head and Neck Surgery, 152(2), S1–S39. https://doi.org/10.1177/0194599815572097

Yasir, M., Sonthalia, S., & Goyal, A. (2023, July 3). Corticosteroid adverse effects. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK531462/

Image: Hospital for Special Surgery. (n.d.). Steroid side effects: How to reduce corticosteroid side effects. Retrieved from https://www.hss.edu/conditions_steroid-side-effects-how-to-reduce-corticosteroid-side-effects.asp

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