Evaluation of laryngeal findings in users of inhaled steroids

Abstract

The objective of the prospective study is to examine the laryngeal changes by laryngeal videostroboscopy and electromyography (EMG) regarding new-onset dysphonia in asthmatic patients taking inhaled corticosteroids (ICS). Laryngeal changes and electrophysiological status of the laryngeal muscles were evaluated by these methods in 12 patients both at the time of presentation of dysphonia and after cessation of therapy. Laryngeal changes of our patients were mucosal edema, erythema, thickening, adduction deficit, nodule and irregularity in videostroboscopy. Significant correlations were found between laryngeal pathology and dosage and duration of ICS therapy. We detected myopathy by EMG in most of the patients. Also, EMG revealed that cricothyroid muscle was much more affected than thyroarytenoid muscle. In conclusion, we consider that steroid myopathy or mucosal inflammatory theory alone is not sufficient to explain the etiopathogenesis of dysphonia in asthmatic patients taking ICS. The laryngeal mucosal changes were detected by laryngeal videostroboscopic examination in some asthmatic patients, with dysphonia using ICS, and/or laryngeal myopathy was found by laryngeal EMG in some of them in this study. Thus, various factors may have role simultaneously in the occurrence of dysphonia.

Clinical Practice Guideline: Hoarseness (Dysphonia) (Update)

“…Additionally, there are many reports implicating long‐term inhaled steroid use as a cause of dysphonia 82,262–268 . A theorized mechanism is mucosal deposition of the inhaled corticosteroids and associated mild myopathy of the thyroarytenoid muscle.…”

The prevalence of pediatric voice and swallowing problems in the United States

“…Comparisons were conducted to determine differences in gender‐related prevalence of the voice or swallowing problem with the chi‐square test with statistical significance set at P = 0.05. Because the use of inhaled corticosteroids has been associated with an increased prevalence of dysphonia, data regarding the presence or absence of asthma were extracted, and comparisons were also conducted to determine if the presence of active asthma (defined as active if the adult respondent was told by a doctor that the child still has asthma vs. having had asthma, now inactive) was associated with either the voice problem or the swallowing disorder among children …”

Histopathological Analysis of the Effects of Corticosteroids on Vocal Cords: Experimental Study

“…Babu and Samuel et al [14] evaluated the upper aerodigestive tracts of 48 consecutive patients who underwent ICS therapy (with beclomethasone); 20 % of patients experienced voice changes, 46 % had congested erythematous vocal cords, and 8.5 % had adductor palsy with vocal cord bowing. Videolaryngostroboscopic analysis revealed mucosal edema, erythema, thickening, adduction deficits, nodules, irregularity, and supraglottic hyperfunction [15,16]. Our study revealed no macroscopic differences between groups.…”

“…Further studies combining mucosal and electrophysiological data are required to address the possibility that the etiology of dysphonia is due to steroid myopathy [15,16].…”

“…A mean of 39 % cycle-to-cycle irregularity was detected along with a reduced maximum phonation time in 73 % of cases. Ozbilen et al [15] evaluated the larynx using electromyography, and found that the cricothyroid muscle was more affected than the thyroarytenoid muscle. However, it was concluded that steroid myopathy or mucosal inflammatory theory alone is insufficient to explain the etiopathogenesis of dysphonia in asthmatic patients, because these problems were not seen in all patients using ICS with dysphonia.…”