When is prednisone (corticosteroid) used to treat laryngitis?

Prednisone Use in Laryngitis

Prednisone should not be routinely prescribed for laryngitis due to lack of evidence for benefit and significant potential for harm. 1

General Recommendations for Laryngitis Treatment

• Corticosteroids (including prednisone) should not be empirically prescribed for hoarseness or laryngitis before visualization of the larynx 1
• Acute laryngitis is typically self-limited, with most patients experiencing improvement within 7-10 days regardless of treatment 1
• Antibiotics are also not recommended for routine treatment of laryngitis as most cases are viral in origin 1

Specific Circumstances Where Prednisone May Be Considered

Prednisone may be appropriate in limited circumstances after laryngoscopy confirms the diagnosis:

• In professional voice users with confirmed allergic laryngitis who are acutely dependent on their voice 1
• In cases of severe airway obstruction after appropriate evaluation and determination of the cause 1
• In certain autoimmune disorders involving the larynx (systemic lupus erythematosus, sarcoidosis, granulomatosis with polyangiitis) 1, 2
• In pediatric patients with croup and associated symptoms including hoarseness 1

Risks of Corticosteroid Therapy

Short and long-term corticosteroid use carries significant risks:

• Cardiovascular: hypertension, cardiovascular disease, cerebrovascular disease 1
• Metabolic: lipodystrophy, diabetogenesis, weight gain 1
• Musculoskeletal: osteoporosis, myopathy, avascular necrosis 1
• Ophthalmic: cataracts 1
• Gastrointestinal: peptic ulcers, pancreatitis 1
• Other: impaired wound healing, increased infection risk, mood disorders 1

Decision-Making Algorithm for Prednisone Use in Laryngitis

1. Perform laryngoscopy to visualize the larynx before considering steroid therapy 1
2. Determine if patient falls into a special category:
   • Professional voice user with allergic laryngitis requiring immediate voice use
   • Patient with autoimmune disorder affecting the larynx
   • Child with croup and associated symptoms
   • Patient with severe airway compromise
3. If none of these conditions apply, avoid prednisone and recommend:
   • Voice rest
   • Adequate hydration
   • Humidification
   • Avoidance of irritants (smoking, alcohol)
4. If prednisone is deemed necessary after visualization:
   • Use the lowest effective dose for the shortest duration
   • Discuss risks and limited evidence for benefit with the patient
   • Monitor for adverse effects

Important Caveats

• Empiric use of steroids without visualization of the larynx may delay appropriate diagnosis and treatment 1
• The risk-benefit ratio must be carefully considered in each case, as the evidence for benefit is limited while risks are well-documented 1
• Single-dose or short-term steroid therapy appears to have a lower risk of severe complications, but potential risks still exist 3