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.
