Is prednisolone (corticosteroid) effective for treating hoarseness due to a common cold?

Prednisolone for Hoarseness Due to Common Cold

Prednisolone should not be used for treating hoarseness due to the common cold as it offers no proven benefit while exposing patients to potential side effects. 1

Evidence Against Systemic Corticosteroid Use

The American Academy of Otolaryngology-Head and Neck Surgery provides a strong recommendation against the routine use of corticosteroids for hoarseness and laryngitis:

• There is an overwhelming lack of supporting data on efficacy of oral steroids for hoarseness 1
• Potential for significant and serious side effects from corticosteroids, even with short-term use 1, 2
• The risk-benefit assessment shows a preponderance of harm over benefit for steroid use in this context 1

Pathophysiology and Natural Course

Hoarseness during a common cold is typically caused by:

• Viral inflammation of the larynx (laryngitis) 1, 2
• Increased sensitivity of afferent sensory nerves in the upper airway 1
• Postnasal drip irritating the larynx 1

Most cases of acute laryngitis are self-limited, with improvement occurring within 7-10 days without specific treatment 1, 2

Recommended Management Approach

For hoarseness associated with the common cold:

1. Conservative measures (first-line treatment):

   • Voice rest 1, 2
   • Adequate hydration 1, 2
   • Humidification 2
   • Avoidance of irritants (smoking, alcohol) 2
   • Throat lozenges or warm liquids for symptomatic relief 2

2. Symptomatic treatments that may help:

   • Older first-generation antihistamine/decongestant combinations may reduce cough and hoarseness 1
   • NSAIDs may help reduce inflammation and associated symptoms 1, 3
   • Zinc (acetate or gluconate) may modestly reduce symptom duration 3

Special Considerations

While systemic steroids are generally not recommended for common cold-related hoarseness, there are limited exceptions:

• Professional voice users with allergic laryngitis may benefit from short-course systemic steroids, but this must be a shared decision after discussing risks 2
• Pediatric patients with croup (which can include hoarseness) may benefit from systemic steroids 1, 2

When to Seek Further Evaluation

Laryngoscopy is recommended when:

• Hoarseness persists beyond 3 months 1
• A serious underlying cause is suspected (e.g., unexplained weight loss, hemoptysis, progressive difficulty breathing) 1, 2
• Hoarseness fails to resolve within 2-3 weeks 2

Common Pitfalls to Avoid

1. Inappropriate antibiotic use: Most cases are viral in origin, and antibiotics are ineffective and may increase the risk of laryngeal candidiasis 1, 2

2. Prolonged use of decongestants: While they may provide short-term relief, prolonged use can lead to rhinitis medicamentosa 1

3. Assuming all hoarseness is benign: Persistent hoarseness beyond 2-3 weeks requires evaluation to rule out more serious conditions 1, 2

4. Overlooking voice hygiene: Simple measures like voice rest and hydration are often overlooked but form the cornerstone of treatment 2