סטרואידים סיסטמיים בעת מגפת ה covid19

[מירי פאהן]

האם ניתן לטפל בקורס סטרואידים סיסטמיים  (60 מג ליום לשבוע או מינון מעט גבוה מזה) במצב של חרשות פתאומית. טיפול מקובל בהעדר המגפה

[ברוך קוניבסקי]

אין עדיין מספיק נסיון ומקרים לגבש הנחיות ברורות,

מתוך ההנחיות שנמצאו ב BSO (British Society of Otology):

Steroid use for treatment of otological conditions
Within otological practice, steroids are commonly used to treat Meniere’s Disease, Sudden Sensorineural Hearing Loss (SSNHL) and idiopathic facial palsy (Bell’s palsy).

Current opinion is that high dose steroid use, whether to manage Covid 19 infection or to treat an unrelated condition, may be associated with a worse outcome6,7. The use of high dose oral steroids is therefore not recommended to treat either Meniere’s Disease or Sudden Sensorineural Hearing Loss (SSNHL). The systemic dose of steroid following intra-tympanic treatment is significantly lower than that of oral treatment, and it is therefore likely that the impact on COVID-19 outcomes will be less. It is therefore preferable to use intra-tympanic steroid to treat these conditions. There is, however, no evidence base for this assumption, and the potential impact on outcome of COVID-19 infection following intra-tympanic steroid use should be discussed with the patient and informed consent obtained prior to proceeding. Whether or not to proceed should be decided on a case-by-case basis.

If undertaking intra-tympanic treatments, it has been usual practice to ask the patient to spit and not swallow for 20 minutes after the injection. This should be avoided during the COVID-19 pandemic as spitting generates aerosol containing viruses.

In idiopathic facial palsy, the use of oral steroids should be discussed with the patient. Evidence from the Scottish Bell’s Palsy study suggests that the use of oral steroids improves recovery from 85% to 96%8. The potential risks and benefits of oral steroid use during the current pandemic need to be made clear and a balanced decision made. For patients with known COVID-19 infection the balance may weigh towards avoiding steroids. For those not believed to be infected the balance of risk may weight towards treatment with steroids.

[מאת]

תגובות