How effective are steroids versus vocal rest in combating vocal fold inflammation from voice overuse?
Background: Clinicians routinely treat acute vocal fold inflammation or laryngitis with oral or intramuscular steroids; however, biological evidence to support this clinical practice has not previously been investigated in humans. Questions still arise regarding the relative value of steroids versus voice rest in acute vocal fold inflammation treatment associated with phonotrauma.
Study design: Prospective, individual, randomized, double-blinded, controlled trial.
Setting: University of Pittsburgh Voice Center.
Synopsis: Participants included 10 healthy females who were randomized to treatment with oral hydrocortisone or placebo. During September and October 2011, each participant was given treatment in three doses over 20 hours after the experimental induction of acute phonotrauma. (Participants talked for one hour at a level of 75 to 90 dB.) Secretions were then collected from subjects’ true vocal folds before and after vocal loading and at four and 20 hours after treatment. Cytokines associated with inflammation and healing were measured in the laryngeal secretions. All participants demonstrated great variability in the degree of change observed for all three inflammatory markers; however, the steroid group clearly showed a decrease in proinflammatory mediators IL-b and IL-6 and an increase in the anti-inflammatory mediator IL-10 at the final time point compared to the control group. Limitations included lack of clarity in some interpretations of cytokine changes and the fact that half of the study’s cohort was deemed nonresponsive based on pre- to post-loading cytokine values.
Bottom line: The evidence supports the use of steroids for acute vocal fold inflammation associated with phonotrauma.
Citation: Ingle JW, Helou LB, Li NY, Hebda PA, Rosen CA, Abbott KV. Role of steroids in acute phonotrauma: a basic science investigation. Laryngoscope. 2014;124:921-927.