From the Guidelines
Dexamethasone is a widely used corticosteroid in ENT practice, particularly for its potent anti-inflammatory and anti-edema effects, and its use is supported by recent guidelines, such as those published in 2019 1.
Uses of Dexamethasone in ENT Practice
- For acute sinusitis, dexamethasone can be prescribed as a short course of 0.5-1 mg daily for 5-7 days alongside antibiotics to reduce mucosal inflammation and improve drainage.
- In cases of severe allergic rhinitis, a single dose of 8-12 mg intramuscularly can provide rapid relief of symptoms.
- For post-tonsillectomy pain management, dexamethasone 0.15-0.5 mg/kg (maximum 10 mg) as a single intravenous dose during surgery significantly reduces pain, nausea, and vomiting.
- In the management of sudden sensorineural hearing loss, a common regimen includes oral dexamethasone 10 mg daily for 7-14 days, with gradual tapering, or intratympanic injections of 4 mg/ml when systemic therapy is contraindicated, as supported by recent studies 1.
- For laryngeal edema or croup, dexamethasone 0.6 mg/kg (maximum 16 mg) as a single oral or intramuscular dose is effective.
Mechanism of Action
Dexamethasone works by suppressing inflammatory mediators, reducing capillary permeability, and inhibiting prostaglandin synthesis, which explains its effectiveness in reducing inflammation and edema in ENT tissues.
Side Effects
Side effects are minimal with short-term use but can include hyperglycemia, mood changes, and increased susceptibility to infection with prolonged administration, as noted in several studies 1.
Recent Guidelines and Studies
Recent guidelines and studies, such as those published in 2019 1, support the use of dexamethasone in ENT practice, particularly for the management of sudden sensorineural hearing loss and other conditions. However, the use of dexamethasone should be individualized and based on the specific condition being treated, as well as the patient's medical history and other factors.
From the Research
Use of Dexamethasone in ENT Practice
- Dexamethasone, a corticosteroid, is used in the treatment of sudden sensorineural hearing loss (SSNHL) in Ear, Nose, and Throat (ENT) practice 2, 3, 4, 5, 6.
- The medication can be administered through intratympanic injection, where it is injected directly into the middle ear space through the tympanic membrane 2, 3, 4, 5.
- Studies have shown that intratympanic dexamethasone can be beneficial in treating patients with SSNHL, with significant improvement in pure-tone averages (PTA) and hearing recovery rates 2, 3, 4, 5.
- Systemic high-dose dexamethasone therapy has also been found to be effective in treating SSNHL, with a high percentage of patients showing functionally relevant recovery of hearing 6.
Efficacy of Dexamethasone
- The efficacy of dexamethasone in treating SSNHL has been compared to other corticosteroids, such as methylprednisolone and triamcinolone, with no significant difference found in the effect between dexamethasone and these medications 3, 5.
- The response rate to treatment with intratympanic dexamethasone has been reported to be around 70-80% 4, 5.
- Factors that can affect the efficacy of dexamethasone in treating SSNHL include the duration of symptoms, presence of vertigo, and severity of hearing loss 2, 3, 6.
Administration and Dosage
- The dosage and administration of dexamethasone can vary depending on the specific treatment protocol, with some studies using a dose of 5 g/L/d for intratympanic injection 2, 3 and others using a dose of 40 mg daily for systemic therapy 6.
- The treatment protocol can also involve multiple injections or doses, with some studies using a course of at least 7-day treatment 2, 3.