Examples

Nasal sprays (inhalants)

Oral (systemic) corticosteroids

Corticosteroids may be applied directly onto the mucous membranes (topically) as a nasal spray or taken by mouth (orally). Oral corticosteroids are used only rarely to treat sinusitis.

How It Works

Corticosteroids are a group of medicines that reduce or prevent inflammation of the nasal mucous membranes by altering the actions of various cells of the immune system.

Why It Is Used

Corticosteroids are not often used to treat sinusitis. But when you have acute sinusitis (symptoms for less than 4 weeks), corticosteroids might be tried for a short time if you have:¹

• Tried other treatment but it has not helped.
• Polyps within your nose.
• Severe swelling within the nose (mucous membrane).

Corticosteroids may be used to treat chronic sinusitis (symptoms have lasted 8 weeks or longer) that is complicated by allergies or by growths in the mucous membrane (nasal polyps).

How Well It Works

Corticosteroids are likely to reduce symptoms of sinusitis.² Corticosteroids are generally effective in reducing swelling, and they probably help sinusitis by reducing swelling of the mucous membranes. They may also reduce the size of nasal polyps.

Corticosteroid treatment cannot cure viral or bacterial sinusitis, but it can relieve the symptoms.

Oral corticosteroids are extremely effective at reducing inflammation quickly, but prolonged use can cause serious side effects, such as thinning of the bones, diabetes, and increased risk of infection. Corticosteroid nasal sprays at the recommended doses generally don't cause these side effects.

Side Effects

Side effects of corticosteroid nasal sprays are rare and minimal, even after long periods of continuous use. The most common complaint is a burning sensation in the nose right after the spray is used. You may experience an unpleasant aftertaste or some dryness in the nasal mucous membranes. Nosebleeds occur in some people using the nasal spray.

Rare side effects of nasal corticosteroids include:

• Sores in the nose.
• A hole (perforation) that forms in the wall between the nostrils (septum).

Oral corticosteroids used for more than a couple of weeks can have serious side effects. Side effects may include:

• Skin or muscle wasting (atrophy).
• Increased bruising.
• Increased blood pressure.
• Weight gain or fluid retention.
• Increased bone loss, contributing to osteoporosis.
• Damage to the blood supply of the bones that can kill bone cells (avascular necrosis).
• Slowing a child's growth.
• Worsening of diabetes.
• Eye complications (glaucoma, cataracts).
• Increased risk of stomach ulcer.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

Nasal sprays containing corticosteroids cause few side effects and do not lead to swelling of the membrane that lines the nose and sinuses when you stop taking them (rebound congestion). Rebound congestion is a serious side effect of nonprescription decongestant nasal sprays.

Corticosteroids are not the kind of steroids used for muscle building. People do not "bulk up" when using corticosteroids.

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Citations

1. Joint Council of Allergy, Asthma, and Immunology (2005). The diagnosis and management of sinusitis: A practice parameter update. Journal of Allergy and Clinical Immunology, 116(6 Suppl): S13–S47.

2. Ah-See, K (2008). Sinusitis (acute), search date August 2007. Online version of BMJ Clinical Evidence. Also available online: http://www.clinicalevidence.com.