Hone S W, Donnelly M J, Robertson J, Coakley R, O'Neill S, Walsh M J
Department of Otolaryngology/HNS, Mater Misericordiae Hospital, Dublin, Ireland.
Rev Laryngol Otol Rhinol (Bord). 1996;117(4):331-3.
Dysphonia or hoarseness is a well recognised but poorly understood complication of inhaled steroid therapy. 20 asthmatics were investigated, using a perceptual rating score of hoarseness, videolaryngoscopy and videostroboscopy, prior to and after three months of high dose inhaled steroid therapy (1 mg/day). A group of 22 healthy volunteers acted as controls. Prior to commencing inhaled steroid therapy six of the asthmatics were hoarse. Erythema and oedema was noted in 10 asthmatics and vocal fold nodules in 2 asthmatics. 4 of the control group had erythema and oedema. There was significantly more vocal fold pathology in the asthmatic group, p = 0.0135. After three months of inhaled steroid therapy, improvement in voice was noted in 2 of the 6 hoarse asthmatics. This was associated with resolution of vocal fold nodules in one case and with resolution of oedema in another. One asthmatic developed a mid glottic chink. This study demonstrates that asthmatics have significantly more vocal fold pathology than healthy controls. These findings improve with commencement of inhaled steroid therapy. The development of steroid induced myopathy of the vocal folds is a possible cause for the development of a mid glottic chink in one of our subjects. Further studies are necessary to investigate this area further.
发音障碍或声音嘶哑是吸入性类固醇治疗中一种广为人知但却了解甚少的并发症。对20名哮喘患者进行了研究，在高剂量吸入性类固醇治疗（1毫克/天）三个月前后，采用声音嘶哑的感知评分、视频喉镜检查和频闪喉镜检查。一组22名健康志愿者作为对照。在开始吸入性类固醇治疗前，6名哮喘患者声音嘶哑。10名哮喘患者出现红斑和水肿，2名哮喘患者出现声带小结。对照组中有4人出现红斑和水肿。哮喘组的声带病变明显更多，p = 0.0135。吸入性类固醇治疗三个月后，6名声音嘶哑的哮喘患者中有2人声音改善。这在一例中与声带小结消退有关，在另一例中与水肿消退有关。一名哮喘患者出现声门中部裂隙。这项研究表明，哮喘患者的声带病变明显多于健康对照。随着吸入性类固醇治疗的开始，这些发现有所改善。类固醇诱导的声带肌病的发展可能是我们一名受试者出现声门中部裂隙的原因。需要进一步研究以深入调查这一领域。
