Will a steroid dose pack help with hoarseness after a viral infection?

Steroid Dose Pack for Post-Viral Hoarseness

Steroid dose packs should not be routinely prescribed for hoarseness after a viral infection due to the preponderance of harm over benefit. 1

Evidence Against Routine Steroid Use for Post-Viral Hoarseness

• The American Academy of Otolaryngology-Head and Neck Surgery strongly recommends against the routine use of corticosteroids for hoarseness, including post-viral hoarseness, due to lack of supporting data on efficacy and potential for significant adverse effects 1
• Acute laryngitis following viral infections is typically self-limited, with most patients experiencing improvement within 7-10 days without specific treatment 1
• Corticosteroids have numerous documented side effects even with short-term use, including hypertension, cardiovascular disease, impaired wound healing, mood disorders, and increased infection risk 1, 2
• Visualization of the larynx should occur before considering steroid therapy to avoid delaying appropriate diagnosis and treatment 2

Limited Circumstances Where Steroids Might Be Considered

• Steroids may be appropriate in professional voice users with confirmed allergic laryngitis who are acutely dependent on their voice performance 1, 2
• In these specific cases, the risk-benefit ratio might favor a short course of steroids, though this should be an exception rather than routine practice 1, 2
• Pediatric patients with croup and associated symptoms including hoarseness may benefit from systemic steroids, but this is a different clinical entity than post-viral hoarseness in adults 1, 3

Risks of Corticosteroid Therapy

• Cardiovascular risks: hypertension, cardiovascular disease, cerebrovascular disease 1, 2
• Metabolic risks: lipodystrophy, diabetogenesis, weight gain 1, 2
• Musculoskeletal risks: osteoporosis, myopathy, avascular necrosis 1, 2
• Other risks: impaired wound healing, increased infection risk, mood disorders, cataracts, peptic ulcers 1, 2
• Long-term inhaled steroid use has been reported as a cause of hoarseness, potentially worsening the condition 1, 4

Alternative Management Approaches

• Watchful waiting is appropriate as most cases resolve spontaneously within 7-10 days 1
• Voice rest and adequate hydration are supportive measures that may help recovery 1
• Antibiotics should not be routinely prescribed as most cases are viral in origin 1

Important Caveats

• The temptation to prescribe systemic steroids for acute or chronic hoarseness should be avoided due to potential for significant adverse effects 1
• Empiric use of steroids without visualization of the larynx may delay appropriate diagnosis and treatment of underlying conditions 2
• The risk-benefit ratio of steroid use must be carefully considered in each case, as the evidence for benefit is limited while risks are well-documented 1, 2

In conclusion, while steroid dose packs are commonly prescribed for hoarseness including post-viral cases, current evidence does not support this practice for routine care. The potential risks outweigh the benefits in most patients, and watchful waiting is the recommended approach as most cases resolve spontaneously.