From the Guidelines
Prescribing a steroid taper is not guideline-based for muscle tightening in the trapezius causing bruxism or for tonsillar hypertrophy. For trapezius muscle tightness leading to bruxism, first-line treatments include physical therapy, muscle relaxants like cyclobenzaprine (5-10mg at bedtime), massage therapy, stress management techniques, and night guards for teeth protection. Steroids are not indicated as they don't address the underlying causes of muscle tension and carry significant side effect risks with limited evidence of benefit. For tonsillar hypertrophy, treatment depends on severity and symptoms. Mild cases may be observed, while significant airway obstruction or recurrent infections might warrant referral to ENT for possible tonsillectomy, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 1. Short courses of antibiotics may be appropriate for bacterial tonsillitis, but systemic steroids are generally reserved for severe cases of airway compromise as a temporary measure while arranging definitive care, as suggested by the American Academy of Pediatrics 1. Steroids don't provide long-term resolution for either condition and expose patients to unnecessary risks including immunosuppression, metabolic effects, and adrenal suppression.
Some key points to consider in the management of tonsillar hypertrophy include:
- Tonsillectomy is effective for control of sleep-disordered breathing (SDB) in 60%-70% of children with significant tonsillar hypertrophy 1
- The decision to perform tonsillectomy should be based on clinical history, examination, and the likelihood that tonsillectomy will improve sleep and lead to improvements in day- and nighttime symptoms 1
- Polysomnography (PSG) is recognized as the most reliable and objective test to assess the presence and severity of SDB, but it is not always necessary for diagnosis 1
- Clinicians should counsel patients and caregivers regarding the importance of managing posttonsillectomy pain and the potential for persistent or recurrent SDB after tonsillectomy 1
In summary, steroid tapers are not recommended for muscle tightening in the trapezius causing bruxism or for tonsillar hypertrophy, and treatment should be guided by the severity and symptoms of the condition, with a focus on addressing the underlying causes of the condition and minimizing unnecessary risks.
From the Research
Steroid Taper for Muscle Tightening in the Trapezius Causing Bruxism
- There is no direct evidence to support the use of steroid tapers for muscle tightening in the trapezius causing bruxism 2.
- However, a study found that adenotonsillectomy could improve bruxism significantly in children who have obstructive symptoms due to adenotonsillar hypertrophy, suggesting a possible link between tonsillar hypertrophy and bruxism 3.
Steroid Taper for Tonsillar Hypertrophy
- A study reviewed the literature on conservative treatments for adenoidal hypertrophy, including the use of topical nasal steroids, but did not specifically address the use of steroid tapers 4.
- Another study found that intravenous steroids can decrease post-tonsillectomy nausea/vomiting and immediate pain scores in children and adults, but did not address the use of steroid tapers for tonsillar hypertrophy specifically 5.
- A prospective study with retrospective analysis found that oral steroids can reduce postoperative tonsillectomy pain and nausea/vomiting, but did not address the use of steroid tapers for tonsillar hypertrophy specifically 6.
Guideline-Based Prescriptions
- There is no direct evidence to support the use of steroid tapers for muscle tightening in the trapezius causing bruxism or for tonsillar hypertrophy as a guideline-based prescription.
- The available evidence suggests that adenotonsillectomy and the use of steroids in various forms (e.g., intravenous, oral) may be effective in reducing symptoms related to tonsillar hypertrophy and bruxism, but the use of steroid tapers specifically is not well-supported by the available evidence 2, 4, 3, 5, 6.