Prednisone for Ear Issues

[TravelDave]

After having some severe ear issues while diving in Utila 6 years ago (and milder issues on some previous trips), my ENT back home (also a diver) prescribed me a combination of Prednisone and Flonase to use as preventative measures for subsequent trips. This combination has been pretty successful, and it gives me extra comfort that I won't lose a bunch of diving opportunities on expensive trips due to ear issues.

I have since moved to a new town, and have my primary care doc prescribing the Prednisone (the Flonase is now OTC). He has expressed concern that over time this four day regimen (typically taken twice a year) may cause side effects, including infection, adrenal complications, bone loss. Another doc one of my more recent dive trips disagrees and sees little risk given the sporadic and short-term nature of my use of this steroid.

I'm curious what others in the dive community think about the longer-term risks of Prednisone taken over four days, typically twice a year.

Thanks!

 

[RayfromTX]

What dosage?

 

[TravelDave]

What dosage?

10mg x 4 (first 2 days)
10mg x 3 (next 2 days)

 

[RayfromTX]

My doc did not have a problem with a higher regimen than that for me but I am not a dr. He told me 3 weeks ago that if I only took it for 3-4 days I would not even need to taper off. I am scared of the stuff but when I have to use it, it is magic. I use a drop that is a mixture of lidocaine, hydrocortizone and cipro. I save the prednisone for when I can't get out of bed from back spasms. Fortunately that is usually just an annual event.

 

[uncfnp]

That is a moderate dose for a very short term. I would not hesitate to prescribe you that dose and frequency if it is the only steriod use you have and you have no complicationing medical issues such as diabetes.

 

[fmerkel]

That's a high 'standard' dosage. IMO, based on years of playing with this particular issue is you could probably get away with 5-10mg/day for the dive duration starting 1 day before the diving begins. This has pretty minimal impact on the hypo-pituitary axis (adrenal suppression), and essential none on bone density or infection risk. If you can get away with 5mg, so much the better. You can take 5mg for a good while with little risk.
I do this, and have been doing this for any major dive vacation for the last 10 years. The biggest issue is getting an understanding physician willing to prescribe.

You don't want to use this as a major dive crutch. Every time you use it there are consequences. At low doses they are not major and they dissipate over time after you stop to be almost nothing. It ends up being a risk/reward equation. I can do single day dives without, no problem. I cannot do the high end, expensive, important (to me) 3-4 dives/day vacations without some kind of support. Afrin is totally unsatisfactory for this, and 1-2 weeks of Sudafed has it's own price to pay.

Remember, ANY medication has consequences. Aspirin can ruin your stomach. Too much Tylenol can destroy your liver. Prolonged doses of NSAID (all of them) increase you probability of cardiac problems. They all have benefits....and drawbacks. I take Flonase with no issue at all. I know people that get bloody noses after 1-2 weeks of use.Know you medications and what they do TO YOU.

IMO, lower your dose, see if that works, and have a good time.
Make SURE your clearing techniques are excellent. Do not use medication for sloppy clearing techniques.

 

[TravelDave]

Thanks. I'm going to play with the lower doses this trip and see how things go.

 

[uncfnp]

Thanks. I'm going to play with the lower doses this trip and see how things go.

Certainly this is an option but I doubt that will have any significant impact on your long term side effect risk and does place you at higher risk of treatment failure.

I am not a fan of steroids but they do have their use. My issues are not with infrequent, short term use when appropriate but rather recurrent use with questionable need. Too often I have people wanting that "poison oak" or "allergies shot" for minimal symptoms and no idea of the actual medication in that shot nor the long term consequences. Those I worry about, not someone on a four day, twice a year regime.