Steroid Inhaler Laryngitis: Dysphonia Caused by Inhaled Fluticasone Therapy | Laryngology | JAMA Otolaryngology–Head & Neck Surgery | JAMA Network
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Clark  DJLipworth  BJ Adrenal suppression with chronic dosing of fluticasone propionate compared with budesonide in adult asthmatic patients.  Thorax.1997;52:55-58.Google Scholar
Fabbri  LBurge  PSCroonenborgh  L  et al Comparison of fluticasone propionate with beclomethasone dipropionate in moderate to severe asthma treated for one year.  Thorax.1993;48:817-823.Google Scholar
Ayres  JGBateman  EDLundback  BHarris  TAJ High dose fluticasone propionate, 1 mg daily, versus fluticasone propionate, 2 mg daily, or budesonide, 1.6 mg daily, in patients with chronic severe asthma.  Eur Respir J.1995;8:579-586.Google Scholar
Harding  SM The human pharmacology of fluticasone propionate.  Respir Med.1990;84(suppl A):25-29.Google Scholar
Not Available Physicians' Desk Reference.  Montvale, NJ: Medical Economics Co; 2001:621-625, 798-800, 1070-1071, 1153-1154, 1186-1192, 1269-1272, 2828-2835, 2850-2853.
Williamson  IJMatusiewicz  SPBrown  PHGreening  APCrompton  GK Frequency of voice problems and cough in patients using pressurized aerosol inhaled steroid preparations.  Eur Respir J.1995;8:590-592.Google Scholar
Williams  MHKane  CShim  CS Treatment of asthma with triamcinolone acetonide delivered by aerosol.  Am Rev Respir Dis.1974;109:538-543.Google Scholar
Babu  SSamuel  P The effect of inhaled steroids on the upper respiratory tract.  J Laryngol Otol.1988;102:592-594.Google Scholar
Toogood  JHJennings  BGreenway  RWChuang  L Candidiasis and dysphonia complicating beclomethasone treatment of asthma.  J Allergy Clin Immunol.1980;65:145-153.Google Scholar
Pingleton  WWBone  RCKerby  GRRuth  WE Oropharyngeal candidiasis in patients treated with triamcinolone acetonide aerosol.  J Allergy Clin Immunol.1977;60:254-258.Google Scholar
Nishimura  KKoyama  HIkeda  A  et al The effect of high-dose inhaled beclomethasone dipropionate in patients with stable COPD.  Chest.1999;115:31-37.Google Scholar
Williams  AJBaghat  MSStableforth  DECayton  RMShenoi  PMSkinner  C Dysphonia caused by inhaled steroids: recognition of a characteristic laryngeal abnormality.  Thorax.1983;38:813-821.Google Scholar
MacKenzie  CATsanakas  JTabachnik  E  et al An open study to assess the long-term safety of fluticasone propionate in asthmatic children.  Br J Clin Pract.1994;48:15-18.Google Scholar
Fairfax  AJDavid  VDouce  G Laryngeal aspergillosis following high dose inhaled fluticasone therapy for asthma.  Thorax.1999;54:860-861.Google Scholar
Original Article
June 2002

Steroid Inhaler Laryngitis: Dysphonia Caused by Inhaled Fluticasone Therapy

Author Affiliations

From the Department of Otolaryngology–Head and Neck Surgery, Emory University School of Medicine, Atlanta, Ga.

Arch Otolaryngol Head Neck Surg. 2002;128(6):677-681. doi:10.1001/archotol.128.6.677

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.

Design  Case series.

Setting  An outpatient clinic of an academic referral center.

Patients  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.

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

Main Outcome Measure  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.