Oral corticosteroid prescribing habits of Canadian Otolaryngologist-Head and Neck Surgeons

Abstract

Background: Oral corticosteroids (OCSs) are widely prescribed in Otolaryngology-Head & Neck surgery (OtoHNS). There is evidence in the literature regarding specific dosing regimens. However, it is not known to what extent these recommendations are being implemented in practice. Methods: An anonymous online survey was sent to Canadian Society of Otolaryngology-Head and Neck Surgery members (N = 696). Dosing, frequency and tapering of OCSs were assessed in acute rhino-sinusitis (ARS), chronic rhino-sinusitis with (CRSwP) and without polyps (CRSsP), sudden sensori-neural hearing loss (SSNHL), and idiopathic facial nerve/Bell's palsy (IFN). Participants were asked to complete for conditions treated and results were compared with current guidelines. Development of prescribing habits and observed complications were also explored. Results: 124 surveys (18 %) were completed. In CRSwP (N = 98), the median dose was 50 mg (Range: 10-100 mg) and the average duration was 8 days (Range: 1-21 days). In CRSsP (N = 29), the median dose was 50 mg (Range: 20-80 mg) and the average duration was 8 days (Range: 1-14 days). In SSNHL (N = 118), the median dose was 60 mg (Range: 10-120 mg) and the average duration was 10 days (Range: 1-21 days). In IFN (N = 108), the median dose was 50 mg (Range: 10-100 mg) and the average duration was 10 days (Range: 1-21 days). Tapering dosages were used in treating CRSwP (64 %), CRSsP (62 %), ARS (44 %), SSNHL (60 %) and IFN (53 %). Respondents most frequently perceived "Mentor/Preceptor Guidance" as a source of their prescribing habits. Conclusion: There is significant heterogeneity in OCS prescribing habits despite the availability of fairly consistent evidence in the literature for some of the surveyed conditions. Improvements in standardization should be made with the aim of enhancing outcomes and reducing complications.