Glucocorticoids for vocal fold disease: a survey of otolaryngologists.
OBJECTIVE
Glucocorticoids (GCs) are commonly used in the treatment of laryngeal disorders despite the absence of clear guidelines regarding their use. We sought to assess clinical practice patterns regarding GC use for various vocal fold diseases and to ascertain factors underlying the selection of particular GCs for different vocal fold pathology.


METHODS
Prospective, survey.


METHODS
A web-based 20-question survey querying clinical indications for GC use and other factors influencing decision making in GC administration was distributed to 5280 otolaryngologists via e-mail using a commercially available database.


RESULTS
The overall response rate for the survey was 4% (212/5280). Of the respondents, 99% reported GCs to be valuable in their practice. Previous experience/results, familiarity, and use in practice (68%, 54%, and 37%, respectively) were the most commonly cited reasons for choosing a particular GC; pharmacokinetic profile and academic literature were infrequently cited reasons. Fifty-four percent of respondents were more likely to prescribe GCs for vocal performers compared with other patients. Additionally, most respondents stated that the potential for side effects only occasionally prevented GC utilization.


CONCLUSIONS
GC prescription practices vary greatly among otolaryngologists. Drug choice appears to be driven primarily by clinician preference and personal experience rather than by specific pharmacologic or physiologic rationale. These findings likely reflect the current lack of well-constructed studies in the laryngology literature to guide GC selection and administration for benign disorders of the larynx and highlight an important potential area for future studies.
NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, New York.
Nandini
N
Govil
NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, New York.
Benjamin Y
BY
Rafii
NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, New York.
Benjamin C
BC
Paul
NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, New York.
Ryan
R
Ruiz
NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, New York.
Milan R
MR
Amin
NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, New York. Electronic address: ryan.branski@nyumc.org.
Ryan C
RC
Branski
D017723:Drug Utilization Review; D005938:Glucocorticoids / Q000009:adverse effects / Q000627:therapeutic use*; D019983:Guideline Adherence; D019538:Health Care Surveys; D006801:Humans; D020407:Internet; D007818:Laryngeal Diseases / Q000188:drug therapy* / Q000503:physiopathology; D010036:Otolaryngology / Q000639:trends*; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000639:trends*; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D014827:Vocal Cords / Q000187:drug effects* / Q000503:physiopathology; D014832:Voice Disorders / Q000188:drug therapy* / Q000503:physiopathology
D005938:Glucocorticoids
Dysphonia; Glucocorticoid; Steroid; Voice