EpistemisDysphonia induced by inhaled corticosteroids
Specialty: Respiratory.
Why it occurs
- Local myopathy of the intrinsic laryngeal muscles of the vocal cords (direct myotoxic effect induced by the deposition of inhaled corticosteroid in the mucosa of the larynx, affecting the thyroarytenoid muscle)
- Laryngeal or pharyngotonsillar candidiasis (local immunosuppression that favors the colonization and overgrowth of Candida albicans in the vocal cords)
- Chemical or physical irritation caused by propellants (such as norflurane) or excipients (such as lactose) present in dry powder inhalation devices or pressurized cartridges
- Extreme mucosal dryness (due to inhibition of local glandular secretion induced by the drug).
Initial workup
Indirect office laryngoscopy or flexible nasofibrolaryngoscopy (direct inspection of the vocal cords to evaluate mobility, rule out nodules, polyps, neoplasms or whitish plaques suggestive of candidiasis); Smear and culture of whitish pharyngeal plaques if visible.
red flags
Dysphonia that persists more than 4 weeks after the withdrawal or change of the inhaled corticosteroid, presence of progressive dysphagia or pain when swallowing, mild inspiratory stridor, weight loss, or appearance of a palpable lump in the neck.
Standard management
- Exhaustive mouthwashes and gargles with water — performed immediately after each corticosteroid inhalation to mechanically eliminate the drug deposit
- Nystatin — oral suspension, 100,000 IU/mL, prescribing 5 mL for gargling and subsequent swallowing, 4 times a day for 7-10 days if local candidiasis is confirmed
- Fluconazole (100-200 mg orally once a day for 7-14 days in cases of refractory laryngopharyngeal candidiasis or immunocompromized).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Respiratory
- Listed causes
- 4
- Treatment options
- 3