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Three Part Question

In [adults with acute laryngitis], do [glucocorticoids] [reduce dysphonia and speed up recovery]?

Clinical Scenario

A 45 years old female teacher presents to the Emergency Department with severe hoarseness and a mild cough for three days. She hasn’t been able to work since then. Her vital signs and physical examination reveal nothing particular except an important dysphonia. You tell her that she has an acute laryngitis, a self-limited condition that will resolve with voice rest. You wonder if a brief course of corticosteroids can reduce her dysphonia and speed her recovery.

Search Strategy

Search conducted on January 10th 2016
A. There were no completed BestBETs, critical appraisals or Cochrane review found on the topic.
B. The website clinicaltrials.gov was searched for an ongoing trial and none was found
C. MEDLINE (PubMed) (1900-january 2016)
D. EMBASE (<1966-january 2016)
C. MEDLINE (PubMed) (1900-january 2016):
1) (((laryngitis OR "Laryngitis"[Mesh] OR hoarseness OR dysphonia OR laryngeal inflammation) AND (acute)) AND ("Glucocorticoids"[Mesh] OR glucocorticoids OR glucocorticoid OR corticosteroids OR corticosteroid OR "Steroids"[Mesh] OR steroids OR steroid OR dexamethasone OR decadron OR prednisone OR prednisolone))

D. EMBASE (< 1966-january 2016):
1) ((('laryngitis'/exp OR 'laryngitis' OR 'hoarseness'/exp OR 'hoarseness' OR 'dysphonia'/exp OR 'dysphonia' OR 'laryngeal inflammation'/exp OR 'laryngeal inflammation') AND ('acute')) AND (('glucocorticoids'/exp OR 'glucocorticoids' OR 'glucocorticoid'/exp OR 'glucocorticoid' OR 'corticosteroids'/exp OR 'corticosteroids' OR 'corticosteroid'/exp OR 'corticosteroid' OR 'steroids'/exp OR 'steroids' OR 'steroid'/exp OR 'steroid' OR 'dexamethasone'/exp OR 'dexamethasone' OR 'decadron'/exp OR 'decadron' OR 'prednisone'/exp OR 'prednisone' OR 'prednisolone'/exp OR 'prednisolone')))

Search Outcome

C. MEDLINE (PubMed) (1900-january 2016):
1) 226 articles
2) After abstracts review: 2 relevant articles
3) After reading reviews and their references: 1 relevant

D. EMBASE (<1966-january 2016):
1) 718 articles
2) Limit: adult = 228
3) After abstracts review: 1 relevant article (no new article)
4) After reading reviews: 1 relevant article

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Souza AM et al. 2013 Brazil	32 adults with acute dysphonia caused by laryngitis randomized to receive 50 mcg of inhalation fluticasone BID or 20 mg of oral prednisolone BID, both for 7 days.	Single center prospective clinical study	Videolaryngostroboscopy (first and 7th day of treatment): vocal fold hyperemia, edema and muco-undulatory movement (MOM)	Reduction in vocal fold hyperemia, edema and MOM post-treatments. No difference between treatments except less edema with fluticasone (p: 0,012)	No control group, small sample, too specific population: professional voice users, certain issues are less clinically relevant and measuring the outcomes on the 7th day of treatment may be too late considering the expected spontaneous resolution of this self-limited disease.
			Vocal assessment (first and 7th day): fundamental frequency (Fo), jitter, shimmer, neutralized noise energy (NNE) and the harmonic noise ratio (HNR)	Significant improvement in voice quality, roughness, breathiness and NNE for both groups
			Questionnaire (7th day of treatment): voice improvement with the treatment, length of improvement and treatment-related side effects	All patients reported improvements by 5th day of treatment, no difference between groups (peak: 3rd day). 4 patients in prednisolone group reported sides effects (stomach pain and nausea)

Comment(s)

We did not find any randomized control trials on oral glucocorticoids use for acute laryngitis in adults. Our search strategy has elicited only one small study among professional voice users. In Souza et al. 2013, pre- and post-treatment videolaryngostroboscopic and vocal assessments revealed a significant trend toward reduction in edema and subjective voice improvement. However, the absence of a control group is a major flaw in the study design and significantly affects the validity of these results. No conclusions on effectiveness of glucocorticoids in adults with acute laryngitis can be made based on this study.

Clinical Bottom Line

In adults with acute laryngitis, there are currently no sufficient evidences to support the use of oral glucocorticoids to reduce hoarseness and hasten recovery.

Level of Evidence

Level 3 - Small numbers of small studies or great heterogeneity or very different population.

References

1. Andréa Moreira Veiga de Souza, André de Campos Duprat, Rejane Cardoso Costa, Janaína de Oliveira Pimenta, Fernanda Fonseca de Sá Andrade, Fernanda Ferreira da Silva Use of inhaled versus oral steroids for acute dysphonia Braz J Otorhinolaryngol. 2013 Mar-Apr; 79 (2): 196-202