Oral Prednisone Treatment Protocol for Laryngitis
Corticosteroids should not be routinely prescribed for patients with laryngitis due to lack of supporting evidence for efficacy and potential for significant adverse effects. 1, 2
Evidence Against Routine Corticosteroid Use
- 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, 2
- Acute laryngitis is typically self-limited, with patients showing improvement in 7-10 days with supportive care alone 1
- The American Academy of Otolaryngology-Head and Neck Surgery guidelines indicate a preponderance of harm over benefit for steroid use in laryngitis 1
- Antibiotics are also not recommended for routine treatment of laryngitis, as they have not shown effectiveness for this condition 1, 3
Potential Adverse Effects of Corticosteroids
- Side effects from corticosteroids can occur even with short-term use and include sleep disturbances, lipodystrophy, hypertension, and metabolic disturbances 1, 2
- Other risks include impaired wound healing, myopathy, cataracts, infections, mood disorders, and increased susceptibility to infections 1, 2
- Long-term inhaled steroid use has been associated with causing hoarseness and dysphonia (steroid inhaler laryngitis) 1, 4
- Even short courses of steroids carry potential risks of rare but severe complications such as avascular necrosis and exacerbation of chickenpox 5
Special Circumstances Where Corticosteroids May Be Considered
- In patients with allergic laryngitis, especially performers who are acutely dependent on their voice, systemic steroids may provide quick relief, though this is based on limited evidence 1, 2
- For severe cases of laryngitis with significant airway involvement (such as in pediatric croup), corticosteroids have demonstrated benefit, but this should not be extrapolated to typical adult laryngitis 1, 2
- Visualization of the larynx should always be performed before considering any corticosteroid treatment to confirm diagnosis and rule out other causes 1, 2
Recommended Approach to Laryngitis Management
- For most cases of acute laryngitis in adults, supportive care is the recommended approach 1, 2
- Voice rest, adequate hydration, and humidification are appropriate first-line measures 1
- If treatment is deemed necessary in special circumstances (professional voice users with allergic laryngitis), the treatment should be limited to a short course 1, 2
- Avoid antibiotics unless there is clear evidence of bacterial infection 1
Pitfalls and Caveats
- Mistaking chronic laryngitis for recurrent acute episodes - these are distinct clinical entities requiring different management approaches 6
- Failing to distinguish between viral and bacterial etiologies - most cases of acute laryngitis are viral and self-limiting 1, 3
- Using corticosteroids without first visualizing the larynx, potentially missing other diagnoses that require different treatment 1, 2
- Prescribing prolonged courses of steroids, which increases the risk of adverse effects without additional benefit 1, 2