Inhaled steroids (IS) for the treatment of asthma have become a standard in the U.S. and many countries around the world. They are an essential cornerstone in the management of persistent asthma. Adverse effects of IS are minimal, but a small percentage of patients may experience dysphonia (hoarseness, weakness or loss of voice), throat irritation, cough or candida overgrowth (oral thrush).
Many patients who have hoarseness related to IS describe a subtle onset which began months or years after starting the inhaler. There is increased risk of voice change with higher doses or strengths of inhaled steroid. It’s often very frustrating when you have established a good routine of daily inhalations and have reaped the rewards of good asthma control, but later learn the wonder drug is weakening your voice.
Studies have reported between 10-50% of patients on IS experience hoarseness, although package inserts only reflect a range of 1-8%. In my practice it always seems to be a singer,...
When discussing of the symptoms of rheumatoid arthritis, we often talk about pain, stiffness, swelling, and disability. We don’t often talk about vocal quality or ability to breathe freely, but RA can affect the larynx and small joints of the head and neck, including temporomandibular joint (TMJ), the cricoarytenoid joint (CAJ), and the cricothyroid joint (CTJ).
According to a new literature review in the journal Autoimmune Diseases , the prevalence of laryngeal symptoms of RA has risen from up to 31% of RA patients in 1960 (Lawry, 1984) to 75% by the end of the 20th century (Hamdan, 2013). At least a portion of this significant increase is likely due to increased awareness and better clinical diagnosis.
Symptoms of larynx involvement caused by RA include odynophagia (painful swallowing), foreign body sensation, dysphagia (difficulty swallowing), sore throat, lump sensation in the throat, change in voice quality (e.g. hoarseness, breathiness, vocal fatigue), referred ...
Let’s get rid of the word, stigma, once and for all. Every once in a blue moon, I feel the urge to sound off. Please indulge me:
As a word, “stigma” is an insult to the outrages inflicted upon our population. Its use - even by well-meaning people - only perpetuates our status as third-class citizens. A quick history lesson:
In the US, during the first decades of the twentieth century - in the name of the improvement of the human race, with the sanction of the Supreme Court - 30,000 individuals deemed mentally unfit were subjected to enforced sterilization.
In Hitler’s Germany, some 300,000 to 400,000 forced sterilizations were carried out. Then, beginning in 1939, a quarter million mentally and physically disabled people were gassed in special “euthanasia” centers.
We live in a more enlightened age, but the basic premise that we are not welcome as equals in society remains substantially unchallenged. We are no...
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