Steroid therapy of acute ENT infections: rarely indicated.

(1) Apart from acute laryngitis in children, the use of steroids in acute ENT infections is not supported by clinical data. (2) A single dose of steroids (oral or intramuscular dexamethasone, 0.6 mg/kg) has only moderate efficacy in children with acute laryngitis, but it can hasten symptom relief. Available clinical data fail to show whether steroid therapy reduces the frequency of severe respiratory complications in this setting, or if it is helpful in minor cases. (3) There are no published data justifying the use of steroids as adjuvant treatment in other acute ENT infections, such as non allergic rhinitis, sinusitis, pharyngitis, tonsillitis and otitis. Two randomised trials have shown an analgesic effect of steroids in pharyngitis, but there are no published comparisons with standard analgesics such as paracetamol. (4) Severe complications appear to be rare with single-dose and short-term steroid therapy (for less than a week). However, there is a potential risk of rare but severe complications of chickenpox, and avascular necrosis of the femoral head. (5) Routine use of steroids for recurrent ENT infections has the same risks as long-term steroid therapy.