How are glucocorticoids used for laryngeal pathology, and is there a consensus?
Explore this issue:July 2014
Background: Exogenously administered glucocorticoids are used in clinical practice to reduce inflammation, and interventions that modulate inflammation have a powerful therapeutic potential. However, case series that describe glucocorticoid use in a variety of laryngeal disorders are inconsistent and contradictory, and an understanding of the molecular foundations of glucocorticoid action are often not well understood.
Study design: Literature review.
Setting: New York University School of Medicine, New York City.
Synopsis: Glucocorticoids are powerful and complex immunomodulatory drugs that exert their effects through multiple molecular pathways and mechanisms. They inhibit cyclin dependent kinase activity, which eventually block entry into the S phase of the cell cycle, regulating proliferation of both lymphocytes and fibroblasts. The clinical manifestation of these pathway integrations is inflammation suppression. Glucocorticoids modulate each stage of wound healing, influence epithelial permeability, and are a first-line therapy for many diseases in which defective epithelial barrier function is implicated. For asthma treatment, glucocorticoids decrease admission rates, shorten length of stay, and decrease the time to return of normal activities. They are also effective for hypertrophic scars and skin keloids. Many laryngeal disorders result from an abnormal inflammatory response following trauma, autoimmune disorders, or as a primary infectious or inflammatory process. Foundational studies found that glucocorticoids regulate extracellular matrix metabolism within the vocal folds. There is a lack of consensus and a prescription pattern disparity in clinical studies regarding the appropriate use of these drugs. However, they have been recommended without contraindication for laryngeal trauma from extubation and reintubation, Wegener’s granulomatosis are commonly treated with them, and they have been evaluated as an adjunct to medical or surgical management of benign vocal fold lesions.
Bottom line: Glucocorticoids are effective in the treatment of a number of laryngeal pathologies, through both systemic and intralesional administration, although there is no clear published consensus for their use.
Citation: Rafii B, Sridharan S, Taliercio S, et al. Glucocorticoids in laryngology: a review. Laryngoscope. 2014;124;1668-1673.