Hi doc.
I've had a nasty sinus infection which, coupled with smoking and singing at several gigs in a short period of time, has caused some pretty severe inflammation of my throat and vocal cords.
According to my ENT, this infection has been treated several times but apparently never fully went away. So, it seems pretty resistant: two weeks on Amoxicillin and it got worse. I've been on Keflex for 10 days, and have barely spoken a word, but my throat still hurts pretty bad when I speak. My ENT said that steroids were an option once the infection started responding.
My question is this: what can I expect from steroids? Does the infection need to be fully cleared befre I start them (as a singer, I'm looking for the best long-term solution)? Will the inflammation go down quickly or slowly? Is it still bad to talk even though it may not hurt, or do they restore functionality as well as address the symptom? Also, how will I take them?
Thanks for your help,
Reply ------------
I am unclear as to the relationship between your laryngeal condition and sinusitis since you have only described symptoms of throat and larynx inflammation but have not described any sinus symptoms. Throat and voice symptoms in the absence of any sinus symptoms are not likely to be related to sinus disease. You have described laryngeal symptoms consistent with laryngitis and associated vocal cord swelling. Certainly severe sinus infections can be associated with laryngitis but in addition to the hoarseness and sore throat one would also expect nasal drainage, nasal congestion, facial pressure or headache, etc. If your hoarseness and sore throat were indeed initially associated with such sinus symptoms, it is important to note whether the sinus symptoms have improved. If sinus symptoms persist, then you must address the probability of persistent infection in the sinuses which may require "extended spectrum" antibiotics given over a much longer period of time (3-6 weeks) combined with medications designed to decongest and liquify secretions. Common adjuvant medications include topical nasal steroid sprays, expectorants, and decongestants.
If your laryngeal condition was originally triggered by sinusitis, but the sinus symptoms have resolved, leaving only persistent hoarseness and sore throat, continued antibiotic therapy may be unnecessary. It is not uncommon to have vocal cord swelling to persist for several days to a couple of weeks following an acute laryngitis, whether or not it was triggered by an acute sinusitis. If infection has resolved then voice rest and adequate fluid intake are the most important measures. Avoidance of clearing of the throat and coughing are necessary and occasionally require cough suppressants. Avoiding environmental irritants including the most serious - cigarette smoke is extremely important. Short term use of steroids such as prednisone or methylprednisolone are frequently used to speed up the resolution of the vocal cord swelling. Short term use of such steroids is generally safe however they must be used with caution in anyone with serious health problems especially diabetes, stomach ulcers, etc. In otherwise healthy individuals, steroids can be safely used but may cause undesirable short term side effects such as stomach upset, insomnia, or agitation.
If the throat condition has not been associated with sinus symptoms, it is important to consider other causes of laryngitis including vocal misuse, allergy, or gastro-esophageal reflux. These latter conditions may require additional treatment measures in addition to those mentioned in the preceding paragraph. In any situation, where hoarseness, with or without throat pain persists in an adult for more than a few weeks, an examination by an ear, nose and throat specialist is indicated.
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Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
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