From the Guidelines
Medrol (methylprednisolone) dose packs are not recommended for routine symptom management of acute laryngitis due to the lack of supporting evidence and potential for significant side effects. The use of oral steroids for empiric treatment of dysphonia and presumed acute laryngitis is discouraged, as stated in the clinical practice guideline: hoarseness (dysphonia) update 1. This guideline highlights the overwhelming lack of supporting data for the efficacy of corticosteroids in treating dysphonia, except in special circumstances.
The potential side effects of corticosteroids, even with short-term use, include insomnia, gastrointestinal disturbances, mood disturbances, and increased cardiovascular risks 1. Long-term use is associated with more severe risks, such as hip/femur fracture, cataract formation, adrenal insufficiency, diabetes, and changes in bone density. Given these risks, the use of Medrol dose packs should be avoided for routine acute laryngitis management.
Instead, the preferred initial treatments for acute laryngitis include:
- Voice rest
- Adequate hydration
- Humidification
- Over-the-counter pain relievers like acetaminophen or ibuprofen for discomfort. Corticosteroids like methylprednisolone may be considered in severe cases where significant vocal cord inflammation is causing substantial breathing difficulty or when a person has professional voice demands requiring rapid improvement. However, their use should be carefully weighed against the potential risks and benefits. If symptoms persist or worsen, medical evaluation is necessary to rule out more serious conditions 1.
From the Research
Effectiveness of Medrol Dose Pack for Acute Laryngitis
- The use of corticosteroids, such as methylprednisolone (Medrol), for symptom management of acute laryngitis is supported by some studies 2, 3.
- A study published in 2001 suggests that emergency administration of systemic and inhaled glucocorticoids is the basic treatment for glotto-subglottic laryngitis, with a recommended dosage of more than 0.3 mg/kg dexamethasone for 48 hours, followed by oral corticosteroids 2.
- Another study published in 1995 found that a single intramuscular injection of dexamethasone (0.6 mg/kg) shortened the duration and severity of illness in patients with acute viral laryngotracheitis (croup) 3.
- However, there is limited research specifically on the use of Medrol dose packs for acute laryngitis, and more studies are needed to determine its effectiveness.
Comparison with Other Treatments
- A 2015 review of antibiotics for acute laryngitis in adults found that antibiotics do not appear to be effective in treating acute laryngitis when assessing objective outcomes, but may be beneficial for some subjective outcomes 4.
- A 2018 case series on acute infectious laryngitis highlighted the reversible structural changes that can be expected in patients with acute laryngitis and the value of conservative management 5.
- A 2008 review of laryngitis types, causes, and treatments discussed the pathophysiologic mechanisms that are central to the development of acute and chronic laryngitis, including inflammatory processes that affect the unified airway 6.
Dosage and Administration
- The recommended dosage of corticosteroids for acute laryngitis is not well established, but a study published in 2001 suggests that a high dosage of more than 0.3 mg/kg dexamethasone for 48 hours, followed by oral corticosteroids, may be effective 2.
- The use of a Medrol dose pack, which typically contains 4 mg of methylprednisolone per tablet, may be considered for symptom management of acute laryngitis, but the dosage and duration of treatment should be determined by a healthcare professional.