What is the role of systemic steroids, such as prednisone (corticosteroid), in treating acute laryngitis?

Systemic Steroids in Acute Laryngitis

Clinicians should not routinely prescribe systemic corticosteroids for the treatment of acute laryngitis in adults due to the preponderance of harm over benefit and absence of clinical trials demonstrating efficacy. 1, 2

Evidence Against Routine Use

• The American Academy of Otolaryngology-Head and Neck Surgery strongly recommends against routinely prescribing oral corticosteroids to treat 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 2
• There is an overwhelming lack of supporting data for efficacy of systemic steroids in acute laryngitis in adults 1
• The potential risks of corticosteroid therapy outweigh the unproven benefits for routine cases of acute laryngitis 1, 2

Potential Adverse Effects of Systemic Steroids

• Cardiovascular: hypertension, cardiovascular disease, cerebrovascular disease 1, 2
• Metabolic: lipodystrophy, diabetogenesis, weight gain 1
• Musculoskeletal: osteoporosis, myopathy, avascular necrosis 1, 2
• Ophthalmic: cataracts 1, 2
• Gastrointestinal: peptic ulcers, pancreatitis 1, 2
• Other: impaired wound healing, increased infection risk, mood disorders 1

Limited Circumstances Where Steroids May Be Considered

• Professional voice users with confirmed allergic laryngitis who are acutely dependent on their voice 1, 2
• Pediatric patients with croup and associated symptoms including hoarseness 1, 2, 3
• Cases of severe airway obstruction after appropriate evaluation and determination of the cause 2
• Certain autoimmune disorders involving the larynx 2

Management Approach for Acute Laryngitis

• Visualization of the larynx should be performed before considering steroid therapy 1, 2
• Supportive care is the mainstay of treatment for most cases of acute laryngitis 1, 2
• Antibiotics are not recommended for routine treatment of laryngitis as most cases are viral in origin 2
• For pediatric patients with croup-related laryngitis, a single dose of systemic steroids (oral or intramuscular dexamethasone, 0.6 mg/kg) may provide moderate efficacy and hasten symptom relief 4, 3

Important Clinical Considerations

• Empiric use of steroids without visualization of the larynx may delay appropriate diagnosis and treatment 1, 2
• The risk-benefit ratio must be carefully considered in each case, as the evidence for benefit is limited while risks are well-documented 1, 2
• For pediatric cases of subglottic laryngitis (pseudocroup), systemic corticosteroids have demonstrated effectiveness and should be considered first-line therapy in moderate and severe cases 3
• In milder cases of laryngitis, no specific treatment is needed as the disease is self-limiting 3

Conclusion

Based on current guidelines from the American Academy of Otolaryngology-Head and Neck Surgery, systemic steroids should not be routinely prescribed for acute laryngitis in adults due to lack of evidence supporting their efficacy and the potential for significant adverse effects 1, 2. The exception is in specific circumstances such as professional voice users with allergic laryngitis or pediatric patients with croup-related laryngitis, where the benefits may outweigh the risks 1, 2, 3.