Medical Treatment

Medicines Used in Voice Care

Several medicines are commonly used to treat voice disorders. Many of these can be exceptionally helpful, and even essential, to restoring an effective, healthy voice. However, some may be harmful when used inappropriately. In view of this, caution is needed on the part of both the physician and the patient. No medication should be prescribed without a clear reason. Any person with a voice problem should seek to understand:

• why each medication is prescribed
• what the anticipated effect will be
• how long it will take to experience the anticipated effect
• what the side effects are

Sometimes, medications are prescribed without having examined the larynx, especially by physicians who are not otolaryngologists. This may be appropriate for a short period of time, but in any hoarseness that lasts beyond about two weeks without improvement, an examination of the larynx is essential before any further treatment.

Some of the most commonly used medications in laryngology are:

• antibiotics
• antireflux medications
• mucus ‘thinners’
• steroid pills and injections
• steroid inhalers

Antibiotics treat infections caused by bacteria. They are used to treat hoarseness when it is believed to be due to bacterial infection. In fact, bacterial infection rarely causes hoarseness that lasts more than a week in adults. In such cases, treatment with successive rounds of antibiotics may only serves to ‘mask’ illness and delay effective treatment. It is a good idea to reexamine the larynx if a round of antibiotics is ineffective.

Anti-reflux medicine: Acid reflux can be a problem on its own, or contribute to a number of other vocal fold disorders. There are three categories of medicine that all serve to diminish the acidity of stomach juices. Over the counter antacids, like Tums™, Alka-Seltzer™, Mylanta™, Gaviscon™ and various bicarbonate preparations, use a basic substance to counteract acid. H2 blockers (Zantac™, Tagamet™, Axid™), also available over the counter, decrease the production of acid in the lining of the stomach. Proton pump inhibitors (Aciphex™, Dexilant™, Nexium™, Prevacid™, Prilosec™, Protonix™) also act to decrease acid production, and are the strongest of the anti-reflux medications.

Mucus thinners (e.g., guaifenesin) are available with or without a prescription, under a variety of brand names. These are occasionally used for control of throat discomfort. While safe, their efficacy in each individual case is uneven. Contrary to popular belief, “thick mucus” is not a recognized factor related to any voice problem, and may actually represent other types of laryngeal irritation that should be treated appropriately. In general, if mucus thinner preparations are not helpful within a week, there is little reason to continue to use them. Staying well hydrated is equally important, and likely just as effective, in managing this problem.

Steroid pills and injections (prednisone, dexamethasone, Medrol™) are meant to simulate anti-inflammatory substances that the body produces naturally, in response to stress and illness. Steroids are used to reduce swelling in the vocal folds. Like voice rest, they are effective for temporary irritation, but they do not solve any underlying problems. Steroids can also produce many other effects throughout the body, like weight gain, stomach ulcers and osteoporosis. They should be used cautiously, and should not be used over the long-term for voice problems.

There is no doubt that steroids are overused in voice medicine, because they are an easy way of producing a temporary improvement that requires no effort on the part of the patient. Steroids sometimes only delay effective diagnosis and treatment, and create the potential for further harm. Anyone who requires repeated courses of steroids for their voice problem should have their larynx examined (or re-examined) in order to identify and treat the underlying problem.

Inhalers containing steroids are sometimes prescribed in an effort to treat the larynx with steroids, while avoiding harmful steroid effects elsewhere in the body. Steroid inhalers do not have a proven role in most disorders of the larynx, however. They are known to cause hoarseness, vocal fold irritation and potential fungal infection of the throat. They are designed to treat the lungs, and so they deliver unpredictable doses to the vocal folds. In voice disorders, they should be used sparingly, if at all. Granuloma is an exception to this.