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Patient guide

Oral steroids for nose and sinus disease

A short course of oral prednisolone can break the cycle of severe nasal inflammation. Used carefully and infrequently, it is highly effective; used too often, the side effects add up.

Oral steroids (most commonly prednisolone) are used in nose and sinus disease as short, intense courses to break a flare of severe inflammation that nasal sprays alone are not controlling. The aim is to reset the inflammation, restore the sense of smell, open up a blocked nose, and get the patient back to a level where regular nasal treatment can hold things stable. They are not a maintenance treatment.

When they are used

  • Severe chronic rhinosinusitis with nasal polyps, particularly to recover the sense of smell or to reduce polyp size
  • A short pre-operative course before sinus surgery to make the surgery safer and the field cleaner
  • Severe acute exacerbations of CRS that are not settling with sprays and rinses
  • Selected cases of post-viral smell loss within the first few months
  • A small number of other ENT conditions where rapid suppression of inflammation matters

A typical course

Doses and durations are tailored to the condition and the individual. A common pattern is a short reducing course over 7 to 14 days, for example starting at 30 mg of prednisolone once daily and stepping down over the course. Some indications use a single-dose or short fixed-dose course. Take the tablets with food in the morning to reduce stomach irritation and minimise sleep disturbance. Finish the full course as written; for short courses below two weeks, abrupt stopping is generally safe, but always confirm this with the prescribing doctor.

What to expect

In responsive conditions, improvement is rapid. Nasal blockage often eases within 48 hours, the sense of smell starts to return within three to seven days, and polyp size reduces over the course. After the course finishes, the gains can hold for several weeks to months, particularly if regular nasal steroid sprays, rinses and any biologic therapy are continued. They are not a cure; the underlying condition is still there and the same treatment can be needed again in future.

Common side effects of a short course

  • Increased appetite, sometimes weight gain over the course
  • Difficulty sleeping; take the dose first thing in the morning to reduce this
  • Mood changes: irritability, low mood, or in some patients a sense of elevated energy
  • A rise in blood sugar; people with diabetes should monitor closely and adjust treatment with their GP or diabetic team
  • Mild fluid retention and a rise in blood pressure
  • Stomach irritation or heartburn; take with food, and consider a short course of an acid-suppressing medication if you are prone to indigestion
  • Flushing of the face

Most of these are mild and settle within days of finishing the course. Tell the practice promptly if mood changes are severe, if there is significant chest pain, or if blood-sugar control becomes a problem.

Risks of repeated or long courses

The reason oral steroids are used as short, infrequent courses, rather than as ongoing treatment, is that side effects accumulate with cumulative dose. Repeated courses (more than two or three per year) carry risks that occasional courses do not: bone thinning (osteoporosis), cataracts, glaucoma, easy bruising, skin thinning, suppression of the body’s own steroid production, and a higher rate of infections. If your nose and sinus disease is needing more than two or three courses a year to control it, the right answer is usually to step up underlying treatment (biologics, more aggressive nasal treatment or surgery) rather than to use more oral steroids.

Things to avoid or check

  • Live vaccines (e.g. yellow fever, MMR, BCG) should be avoided during and for several weeks after a high-dose course; non-live vaccines (e.g. flu, COVID, pneumococcal) are safe and recommended
  • Tell other clinicians who are seeing you (dentist, anaesthetist, surgeon) that you are on or have recently completed a course
  • If you have type 1 or 2 diabetes, monitor blood sugars closely during the course and tell your diabetes team
  • If you have a peptic ulcer, severe heartburn or have had a GI bleed, mention this before starting
  • Do not stop a long course (more than two to three weeks) suddenly; the dose needs to be tapered to allow the body’s own steroid production to recover

How they fit with other treatment

For chronic rhinosinusitis with polyps, the modern treatment pattern is to use nasal sprays and rinses every day, oral steroid courses only occasionally for flares, and a biologic (omalizumab, dupilumab or tezepelumab) where the disease is severe and steroid-dependent. Biologics significantly reduce the need for oral steroid courses and avoid the cumulative risks. Surgery is offered where medical treatment has been given a fair trial and not held the disease.

When to call the practice

  • Severe mood changes, agitation or thoughts of harm
  • Significant blood-sugar problems if you have diabetes
  • New chest pain or shortness of breath
  • Severe stomach pain or vomiting blood
  • Signs of infection that are not settling, particularly fever

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This guide is general information and not a substitute for individual medical advice. Contact the practice if you have questions about your own care.