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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. Some of these are less so, and may even be harmful when used inappropriately. In view of this, caution is needed on the parts of both the physician and the person with the voice problem in using medicine. No medication should be prescribed without a clear reason. It is reasonable for a person with a voice problem to seek to understand:

  • why each medication is prescribed.
  • what the anticipated effect will be and how long it will take.
  • 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 two weeks, 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 re-examine the larynx if a round of antibiotics is ineffective.

Anti-Reflux medicine: Laryngopharyngeal 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 act to diminish the acidity of stomach juices. Over the counter antacids like Maalox™ and various bicarbonate preparations use a basic substance to counteract acid. H2 blockers (examples: Zantac™, Tagamet™), also available over the counter, decrease the production of acid in the lining of the stomach. Proton Pump inhibitors (Aciphex™, Nexium™, Protonix™, Prilosec™) also act to decrease acid production and are the strongest of the anti-reflux medications.

Reflux is a chronic problem that often requires diligent long-term treatment, extending over months. It is important to understand that changes in dietary patterns are at least as important as medicine in treating reflux, and probably more so over the long term. These should be discussed with your physician.

Mucus thinner (guaifenesin) preparations 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 well-recognized factor in 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. Equally important and possibly just as effective in managing this problem is staying well-hydrated.

Steroid pills and injections (examples: prednisone, Medrol™) are meant to simulate substances the body naturally makes in response to stress and illness, and which reduce inflammation. 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 have 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 in 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 often 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 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 and avoid harmful steroid effects elsewhere the body. Steroid inhalers do not have a proven role in any disorder of the larynx, however. They are known to cause hoarseness, vocal fold irritation and in some cases fungus infection of the throat. They are designed to treat the lungs and they deliver unpredictable doses to the vocal folds. In voice disorders, they should be used sparingly if at all.

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