What is the recommended corticosteroid (e.g. prednisone) dose for treating laryngitis?

Corticosteroid Treatment for Laryngitis

Corticosteroids should not be routinely prescribed for patients with laryngitis prior to visualization of the larynx due to potential adverse effects and lack of supporting evidence for efficacy. 1

Evidence Against Routine Corticosteroid Use in Laryngitis

• Oral steroids are commonly prescribed for hoarseness and acute laryngitis despite an overwhelming lack of supporting data demonstrating efficacy 1
• Systematic searches of medical literature have revealed no studies supporting the use of corticosteroids as empiric therapy for hoarseness or laryngitis except in special circumstances 1
• The temptation to prescribe systemic or inhaled steroids for acute or chronic laryngitis should be avoided because of the potential for significant and serious side effects 1

Potential Adverse Effects of Corticosteroids

• Side effects from corticosteroids can occur with short- or long-term use, although the frequency increases with longer durations of therapy and higher doses 1
• Potential adverse effects include:
  • Sleep disturbances, lipodystrophy, adrenal suppression, metabolic syndrome, weight gain, and hypertension (occurring at an incidence >30%) 1
  • Vertebral fractures (reported at an incidence of 21% to 30%) 1
  • Dose-response relationships documented for fractures, acute myocardial infarction, hypertension, and peptic ulcer 1
  • Other risks include impaired wound healing, myopathy, cataracts, infections, mood disorders, and diabetes 1

Special Circumstances Where Corticosteroids May Be Considered

• In patients with allergic laryngitis, especially performers who are acutely dependent on their voice, the balance of benefit and harm may be shifted 1
• In limited cases, systemic steroids have been reported to provide quick relief from allergic laryngitis for performers, though these are not high-quality trials 1
• For severe cases of postinfectious cough with laryngitis that adversely affects quality of life, prednisone 30-40 mg daily for a short period might be considered when other causes of cough have been ruled out 1

Alternative Management Approaches

• Acute laryngitis is typically self-limited, with patients showing improvement in 7-10 days with supportive care 1
• For pediatric patients with croup (a specific form of laryngitis), corticosteroids have demonstrated benefit, but this should not be extrapolated to adult laryngitis 1
• Voice therapy should be considered for patients diagnosed with hoarseness (dysphonia), with laryngoscopy recommended prior to prescribing voice therapy 1

Clinical Approach to Laryngitis

• Visualization of the larynx (laryngoscopy) should be performed before considering any corticosteroid treatment to confirm diagnosis and rule out other causes 1
• Antibiotics should not be routinely prescribed to treat hoarseness or laryngitis unless there is clear evidence of bacterial infection 1
• For most cases of acute laryngitis in adults, supportive care and allowing the condition to resolve naturally is the recommended approach 1

Conclusion

The evidence strongly recommends against routine use of corticosteroids for laryngitis in adults. While there may be specific circumstances where corticosteroids could be considered (such as in professional voice users with allergic laryngitis), these decisions should be made only after proper laryngoscopic examination and with careful consideration of the potential adverse effects.