Steroid inhaler laryngitis: dysphonia caused by inhaled fluticasone therapy.
OBJECTIVE
To describe a condition that is referred to as steroid inhaler laryngitis, a clinical entity that is caused by the use of inhaled fluticasone propionate and manifested by dysphonia, throat clearing, and fullness.


METHODS
Case series.


METHODS
An outpatient clinic of an academic referral center.


METHODS
The study population consisted of 20 patients with reactive airway disease and dysphonia who were receiving inhaled fluticasone therapy and who were diagnosed as having steroid inhaler laryngitis during the period from January 1998 to June 2000.


METHODS
Cessation of inhaled fluticasone therapy when possible, as well as treatment of other underlying causes of dysphonia, such as laryngopharyngeal reflux and infectious processes.


METHODS
The resolution of dysphonia with cessation of inhaled fluticasone therapy.


RESULTS
Patients with steroid inhaler laryngitis were found to have laryngeal findings ranging from mucosal edema, erythema, and thickening to leukoplakia, granulation, and candidiasis. Patients with more severe mucosal findings were more likely to have laryngopharyngeal reflux as well. Resolution of dysphonia occurred only after discontinuation of the inhaled fluticasone therapy.


CONCLUSIONS
Steroid inhaler laryngitis is a form of chemical laryngopharyngitis induced by topical steroid administration. Symptoms and physical findings mimic laryngopharyngeal reflux, but only respond completely to discontinuation of the inhaled steroid therapy. The otolaryngologist should be familiar with this cause of dysphonia.
DelGaudio
John M
JM
Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, 1365 Clifton Rd NE, Atlanta, GA 30322, USA. john_delgaudio@emoryhealthcare.org
D000280:Administration, Inhalation; D000328:Adult; D000730:Androstadienes / Q000008:administration & dosage* / Q000009:adverse effects*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D005260:Female; D000068298:Fluticasone; D006801:Humans; D007827:Laryngitis / Q000139:chemically induced* / Q000175:diagnosis; D007828:Laryngoscopy; D008297:Male; D008875:Middle Aged; D014832:Voice Disorders / Q000139:chemically induced
D000730:Androstadienes; D000893:Anti-Inflammatory Agents; D000068298:Fluticasone