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Inhaled corticosteroids: hazardous effects on voice-an update
Gregory J Gallivan1, K Holly Gallivan, Helen K Gallivan
1Department of Clinical Surgery, University of Massachusetts Medical School, Worcester, Massachusetts, USA. singingsurgeon@comcast.net
Journal of Voice : Official Journal of the Voice Foundation
|January 31, 2006
Summary
Inhaled corticosteroids (ICS) can cause voice problems like hoarseness. Strobovideolaryngoscopy revealed significant vocal fold abnormalities in patients using ICS, suggesting cessation may be the best treatment.
Area of Science:
- Otolaryngology
- Pulmonology
- Pharmacology
Background:
- Inhaled corticosteroids (ICS) are widely used for asthma management.
- Voice-related side effects of ICS are often under-recognized.
- Hoarseness and dysphonia are common patient complaints linked to ICS use.
Purpose of the Study:
- To investigate the prevalence and nature of voice disorders in patients using ICS.
- To identify specific laryngeal abnormalities associated with ICS therapy using strobovideolaryngoscopy (SVL).
- To evaluate the impact of ICS type, dosage, and duration on vocal health.
Main Methods:
- A cohort of 38 patients with voice complaints related to ICS use underwent 79 strobovideolaryngoscopy (SVL) examinations.
- Patients using various ICS, including fluticasone propionate-based inhalers (Advair Diskus, Flovent), were assessed.
- SVL findings were meticulously analyzed for abnormalities in mucosal wave, glottic closure, and laryngeal dynamics.
Main Results:
- SVL identified significant abnormalities in mucosal wave symmetry/periodicity (76-63%), phase closure (74-63%), and glottic closure (63-59%) in patients using ICS.
- Higher ICS dosage and frequency correlated with increased vocal problems.
- Fluticasone-containing ICS were frequently implicated in steroid inhaler laryngitis.
Conclusions:
- ICS, particularly fluticasone-based formulations, can lead to significant vocal fold dysfunction (steroid inhaler laryngitis).
- SVL is crucial for detecting subtle voice hazards not apparent with standard laryngoscopy.
- Cessation or avoidance of ICS is recommended as the primary treatment for ICS-induced voice problems.