What causes hoarseness with chemotherapy and corticosteroid treatment?

From the Guidelines

Chemotherapy and steroid treatments can cause hoarseness through direct damage to vocal cord tissues, inflammation, and increased susceptibility to infections, as well as through side effects like dry mouth, throat irritation, and acid reflux, as noted in studies such as 1 and 1.

Causes of Hoarseness

The mechanisms by which chemotherapy and steroids lead to hoarseness are multifaceted:

• Chemotherapy drugs can directly damage the tissues of the vocal cords, leading to inflammation and irritation that affects voice quality.
• Steroids, especially when used in high doses or for extended periods, can cause vocal cord thinning, muscle weakness, and increase the risk of fungal infections like oral thrush that can spread to the throat.
• Certain chemotherapy regimens are known to cause severe dry mouth and throat irritation, while others may trigger acid reflux, which can damage the vocal cords.
• Platinum-based chemotherapies, such as cisplatin, are associated with peripheral neuropathy that can affect the nerves controlling the vocal cords, as discussed in the context of antiemetic guidelines 1.

Management and Prevention

To manage hoarseness caused by chemotherapy and steroid treatments, patients should:

• Stay well-hydrated to reduce the risk of dry mouth and throat irritation.
• Avoid throat irritants like smoking and alcohol.
• Use a humidifier to keep the air moist and reduce vocal cord strain.
• Rest their voice when possible to avoid overuse.
• Practice gentle vocal exercises to maintain vocal cord health. If hoarseness persists beyond two weeks or is accompanied by pain, difficulty swallowing, or breathing problems, medical evaluation is necessary, as these could indicate more serious complications requiring specific treatment, highlighting the importance of monitoring and early intervention as suggested by clinical practice guidelines 1.

From the Research

Causes of Hoarse Voice with Chemo and Steroid Treatment

• Hoarseness can be caused by various factors, including acute and chronic laryngitis, functional vocal disturbances, benign and malignant tumors, and neurogenic disturbances 2
• Chemotherapy and radiotherapy can cause voice-related problems, including dysphonia, in patients with head and neck cancer 3
• Certain medications, including anti-angiogenic agents and inhaled corticosteroids, can also cause vocal function changes, including dysphonia 4, 5, 6
• Bevacizumab, an anti-angiogenic agent, has been reported to cause dysphonia in some patients 5
• Inhaled corticosteroids, such as ciclesonide and beclomethasone dipropionate, can also cause voice problems, including dysphonia, although the prevalence may be lower with certain types of ICS 6

Mechanisms and Risk Factors

• The exact mechanisms of hoarseness caused by chemo and steroid treatment are not fully understood, but may involve changes in laryngeal hydration, vocal fold mucosal integrity, and laryngeal muscle function 4
• Patients with head and neck cancer may be at higher risk of developing voice-related problems due to the primary illness and secondary consequences of oncological treatment 3
• Certain medications, such as anti-angiogenic agents and inhaled corticosteroids, may increase the risk of vocal function changes, including dysphonia 4, 5, 6

Treatment and Management

• Voice therapy may be effective in treating functional and organic vocal disturbances, including those caused by chemo and steroid treatment 2
• Surgery on the vocal cords may be indicated to treat tumors and inadequate vocal cord closure 2
• Management of voice problems caused by medications, such as anti-angiogenic agents and inhaled corticosteroids, may involve holding or changing the medication, as well as referral to an ear, nose, and throat specialist for evaluation and treatment 5, 6