Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. C URRENT O PINION Dysphonia associated with the use of inhaled corticosteroids Monika Chmielewska a and Lee M. Akst b,c Purpose of review This article discusses the relationship between inhaled corticosteroids and dysphonia, with discussion of the therapeutic use of inhaled steroids in laryngeal disease and a review of negative laryngeal effects of this class of medication in patients with reactive airway disease. Recent findings Although prescribed for their anti-inflammatory effects (predominantly for pulmonary disease and less often for laryngeal conditions), corticosteroid inhalers can cause laryngeal inflammation. This may relate to chemical irritation from the inhaler itself as well as fungal inflammation related to opportunistic candidiasis that may accompany inhaler use. Patients who suffer from dysphonia because of inhaler use may improve if switched to another inhaler. Studies suggest that ciclesonide metered-dose inhaler may have less oropharyngeal deposition and therefore be associated with reduced oropharyngeal candidiasis and dysphonia compared with other inhaled corticosteroids. Summary Corticosteroid inhalers are a common cause of dysphonia and their use should be investigated in any patient with laryngeal complaints. Keywords dysphonia, inhaled corticosteroids, reactive airway disease INTRODUCTION Inhaled corticosteroids (ICSs) are the mainstay treat- ment for all severities of reactive airway disease. ICSs have been shown to improve lung function, decrease airway hyperresponsiveness, reduce symp- toms and the frequency and severity of asthma exacerbations, and improve quality of life in patients with reactive airway disease [1–5]. In addition, ICSs play a role in successful treatment of inflammatory laryngeal conditions such as acute laryngitis and vocal process granulomas. The systemic side-effect profile of ICSs has been well studied [6 & ]; however, the potential oropharyngeal and laryngeal adverse effects are often underrecog- nized. Local deposition of the particles can lead to oral and upper airway candidiasis, dysphonia and pharyngitis [7]. ICSs are highly effective in the treat- ment of reactive airway disease; however, to ensure patient compliance, the side-effects profile must be considered and addressed. Conversely, to reduce the occurrence of side-effects, an ICS should possess low oropharyngeal deposition and activation, small particle size and activation in the lung [8]. POSITIVE IMPACT OF INHALED STEROIDS ON LARYNGEAL COMPLAINTS Although most cases of acute laryngitis will resolve with conservative management, in some circum- stances (severe symptoms, need for more prompt return to voicing for occupational or performance reasons), acute laryngitis is treated with more than conservative measures. Corticosteroids are used in the treatment of acute laryngitis to reduce inflam- mation, relieve the pain and reestablish mucosal physiology [9]. The indication of steroid use in laryngeal edema is well known [10–14,15 & ]. Topical preparations, in contrast to oral preparations, act a Division of Laryngology, Johns Hopkins Hospital, b Johns Hopkins Voice Center and c Department of Otolaryngology – Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Correspondence to Monika Chmielewska, DO, Fellow, Division of Lar- yngology, Johns Hopkins Hospital, 601N, Caroline Street, 6th Floor, Baltimore, MD 21287, USA. Tel: +1 410 955 1654; fax: +1 410 614 8610; e-mail: mchmlie1@jhmi.edu Curr Opin Otolaryngol Head Neck Surg 2015, 23:255–259 DOI:10.1097/MOO.0000000000000153 1068-9508 Copyright ß 2015 Wolters Kluwer Health, Inc. All rights reserved. www.co-otolaryngology.com REVIEW