Corticosteroid Use in Otolaryngology: Current Considerations During the COVID-19 Era

Otolaryngol Head Neck Surg. 2022 Nov;167(5):803-820. doi: 10.1177/01945998211064275. Epub 2021 Dec 7.


Objective: To offer pragmatic, evidence-informed advice on administering corticosteroids in otolaryngology during the coronavirus disease 2019 (COVID-19) pandemic, considering therapeutic efficacy, potential adverse effects, susceptibility to COVID-19, and potential effects on efficacy of vaccination against SARS-CoV-2, which causes COVID-19.

Data sources: PubMed, Cochrane Library, EMBASE, CINAHL, and guideline databases.

Review methods: Guideline search strategies, supplemented by database searches on sudden sensorineural hearing loss (SSNHL), idiopathic facial nerve paralysis (Bell's palsy), sinonasal polyposis, laryngotracheal disorders, head and neck oncology, and pediatric otolaryngology, prioritizing systematic reviews, randomized controlled trials, and COVID-19-specific findings.

Conclusions: Systemic corticosteroids (SCSs) reduce long-term morbidity in individuals with SSNHL and Bell's palsy, reduce acute laryngotracheal edema, and have benefit in perioperative management for some procedures. Topical or locally injected corticosteroids are preferable for most other otolaryngologic indications. SCSs have not shown long-term benefit for sinonasal disorders. SCSs are not a contraindication to vaccination with COVID-19 vaccines approved by the US Food and Drug Administration. The Centers for Disease Control and Prevention noted that these vaccines are safe for immunocompromised patients.

Implications for practice: SCS use for SSNHL, Bell's palsy, laryngotracheal edema, and perioperative care should follow prepandemic standards. Local or topical corticosteroids are preferable for most other otolaryngologic indications. Whether SCSs attenuate response to vaccination against COVID-19 or increase susceptibility to SARS-CoV-2 infection is unknown. Immunosuppression may lower vaccine efficacy, so immunocompromised patients should adhere to recommended infection control practices. COVID-19 vaccination with Pfizer-BioNTech, Moderna, or Johnson & Johnson vaccines is safe for immunocompromised patients.

Keywords: Bell palsy; Bell’s palsy; COVID-19; ERAS; SARS-CoV-2; adenoid; cancer; chemoradiation; coronavirus; corticosteroid; dupilumab; edema; enhanced recovery after surgery; facia palsy; facial paralysis; head and neck; hearing loss; inflammation; interleukin 4; laryngotracheal stenosis; mRNA vaccine; nasal polyposis; nausea; osteoradionecrosis; otitis media; pediatric; perioperative; posterior glottic stenosis; radiation; rhinology; rhinosinusitis; severe acute respiratory syndrome; sinonasal; sinusitis; steroid; subglottic stenosis; sudden sensorineural hearing loss; tonsillectomy; tracheostomy; vaccination; vaccine; vomiting.

Publication types

  • Review
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Bell Palsy* / drug therapy
  • COVID-19 Vaccines
  • COVID-19*
  • Child
  • Facial Paralysis*
  • Humans
  • Otolaryngology* / methods
  • SARS-CoV-2


  • COVID-19 Vaccines