Misuse of Steroids in Hoarseness of Voice: A Retrospective Study

To retrospectively audit the total number of patients visiting our voice center with hoarseness of voice who had been previously treated with steroids and referred to our center when no improvement was seen. We retrospectively reviewed the documentation and stroboscopies of patients presenting to our voice clinic with change in voice over a period of 2 years and noted how many of these patients had been prescribed steroids with or without any diagnosis. From the voice clinic records, the data of age, gender, presenting complaints, route, duration and dosage of steroid intake was noted. The speciality of doctors prescribing the steroids and the prior laryngeal evaluation was also noted. A total of 164 patients were included in the study where 104 were males and 60 females. Out of 164, 128 patients were seen by ENT surgeons, 26 by general physicians and 10 by chest physicians. Most common presenting complaint was hoarseness of voice (HOV) in 100%of the patients with 5% also having complaints of vocal fatigue dry cough, globus sensation and throat irritation. Primary laryngeal diagnosis had been made in 110 (67%) patients before prescribing steroids. We performed stroboscopies for all 164 patients and further classified the number of patients where steroids were actually indicated which was 104 patients (60%). The total number of patients who visited the voice clinic over the study period of 2 years with change in voice was 1550 which was considered as the denominator. A total of 10.6% patients presenting to our voice clinic with HOV had been prescribed steroids prior to being referred to us. In our study an unindicated use of steroids in hoarseness of voice was seen in 40% of patients who had been prescribed steroids. As a consequence of steroids, fungal laryngitis had developed in 16% of these patients. An accurate diagnosis of HOV prior to treating patients with steroids is essential.