Inhaled corticosteroids: hazardous effects on voice-an update.

Abstract

Inhaled corticosteroids (ICS) have become the prevalent treatment in asthmatics. Hazards to voice are under-recognized. A total of 38 patients with voice complaints associated with the use of ICS were assessed by 79 strobovideolaryngoscopy (SVL) examinations, 24 single and 14 multiple SVL. Hoarseness and dysphonia were the primary reasons for referral. The ICS initially used most frequently was Advair Diskus (fluticasone propionate and salmeterol-inhalation powder-[IP]) in 22 patients, followed by Flovent (fluticasone propionate inhalation aerosol-pressurized metered-dose inhaler-[PMDI]) in 11. Duration of ICS usage varied from 2 weeks to 4-5 years. Higher dosage and frequency of use exacerbated problems. Hazards to voice previously unrecognized by real-time indirect mirror or fiberoptic laryngoscopy were identified by meticulous attention to SVL abnormalities. There was essentially no difference in occurrence of abnormalities whether analyzed from the perspective of the initial 38 or all 79 examinations. These included abnormal mucosal wave symmetry/periodicity (76-63%), phase closure (74-63%), glottic closure (63-59%), mucosal wave amplitude/magnitude (50-35%), supraglottic hyperactivity (39-25%), mucosal quality (34-34%), and glottic plane (10-5%). Candidiasis of the larynx was infrequently observed. Fluticasone ICS were a cause of steroid inhaler laryngitis, and the best treatment was their avoidance or cessation. Further prospective studies ideally might include SVL documented as a pretherapy baseline and then repeated in each ICS patient who developed hoarseness/dysphonia.

• Authors: Gregory J Gallivan, K Holly Gallivan, Helen K Gallivan
• Journal: Journal of voice : official journal of the Voice Foundation (J Voice) Vol. 21 Issue 1 Pg. 101-11 (Jan 2007) ISSN: 0892-1997 [Print] United States
• PMID: 16442776 (Publication Type: Journal Article)

Chemical References

• Adrenal Cortex Hormones
• Androstadienes
• Hazardous Substances
• Fluticasone

Topics

• Administration, Inhalation
• Adolescent
• Adrenal Cortex Hormones (adverse effects)
• Adult
• Aged
• Aged, 80 and over
• Androstadienes (therapeutic use)
• Female
• Fluticasone
• Glottis (physiopathology)
• Hazardous Substances
• Hoarseness (diagnosis, drug therapy, etiology)
• Humans
• Laryngitis (complications, drug therapy, physiopathology)
• Laryngoscopy
• Male
• Metered Dose Inhalers
• Middle Aged
• Severity of Illness Index
• Voice (drug effects)