GLUCOCORTICOIDS FOR VOCAL FOLD

DISEASE: A SURVEY OF
OTOLARYNGOLOGISTS
Journal Reading
Bayu Adiputro
030.10.048

Introduction - Background

Glucocorticoids are used for the

treatment of a wide variety of diseases
Within otolaryngology and laryngology,
GCs are an essential component of
therapy for many kind of conditions.
There is a lack of evidence-based
literature discussing the use of GCs for
other laryngeal processes.

Purpose

The purpose of this study was to better

describe current practice patterns and
factors influencing decision making
regarding GC use for vocal fold disease
among practicing otolaryngologists.

Hypothesis

current clinical decision making

regarding factors is often driven by
subjective factors rather than more
objective factors.

Metode

Waktu dan tempat September 2012,

internet, basis data world wide, pusat
studi di NYU Sch of Med
Sampel 5280 otolaryngologist world
wide, respon 4% (212 orang), data
diambil menggunakan kuesioner berupa
20 pertanyaan multiple choices.
Jenis penelitian prospective survey
Analisis deskriptif dan kuantitatif

RESULTS

Respondent Profile

Perceived efficacy of GCs for specific

laryngeal disorders

wide range of opinions was noted

Most respondents felt that GCs always
or often improved outcomes in the
treatment for some disease.
for the other categories of laryngeal
disease, most respondents felt that GCs
improved outcomes rarely or never.

Route of Administration
Most commonly prescribed DC by route of
administration
Route of Administration
GC *
Intravenous

Dexamethasone (78.8%)
Methylprednisolone (44.2%)

Oral

Hydrocortisone (26.9%)
Prednisone (57.9%)
Methylprednisolone (43.1%)
Prednisolone (42.1%)

Intramuscular

Dexamethasone (31.2%)
Dexamethasone (32.2%)
Methylprednisolone (19.1%)

Direct laryngeal injection

Triamcinolone (13.1%)
Dexamethasone (17.3%)
Triamcinolone (16.3%)
None (61.9%)

Most well-known GCs

package

GC Selection

Previous experience (74.2%) and familiarity

(58.8%) most cited as very important in
influencing the selection of GCs
Half-life and dosing schedule were most often
cited as moderately im-portant factors in choice
of GC (56.8% and 56.5%)
GC mechanism of action, academic literature, side
effect profile, and empirical data were cited as
important factors for less than 50% of
respondents
price and insurance coverage were the least cited

Factors influencing decision-making and

global value

Ninety-nine percent of respondents

reported that GCs were valuable in their
practice
Ninety-eight percent of respondents
indicated that they always or often
visualize the larynx before prescribing
GCs for laryngeal disease
Fifty-four percent of re-spondents were
more likely to prescribe GCs for vocal
per-formers

Morbidity associated with GC use

The percentage of respondents who reported never seeing laryngeal muscle/mucosal atrophy side effects across all routes
of GC ranged from approximately 68-86%
The incidence of laryngeal candidiasis was felt to be
increased in patients given inhaled GCs
Across all routes of administration, approximately 70% of
respondents reported that concern for side effects associated
with GCs occasion-ally prevented their prescription for
laryngeal disease.
for direct laryngeal administration, approxi-mately 40%
replied that side effects occasionally prevented GC
prescription
approximately 50% said that side effects never affected GC
prescription practices

DISCUSSION

there appears to be little consensus

regarding their indications, delivery
methods, and the specific steroid to be
used.
hypotheses were confirmed
This lack of consensus may be related to
several factors including the quantity of
available steroids or the lack of clear
clinical outcomes to base efficacy
studies

the inherent difficulty in designing clinical trials

and the lack of clear patient-based outcome
metrics.
Most interestingly, the vast majority of
respondents in the present study reported little
to no role for GCs for other laryngeal diseases.
The present study confirmed that familiarity
and previous experience were the most cited
factors in GC selection and not factors such as
mechanism of action, dosing schedule, and
half-life

more practical considerations, such as

dosing schedule, may yield more
favorable outcomes
adverse events associated with GC use
are rare in the context of laryngeal
disease.

Limitations

the relatively poor response rate in combination

with the relatively high response from the
international otolaryngology community is a
potential obstacle to the overall generalizability of
the current data
the survey was e-mailed by the commercial vendor,
participants may have been less likely to
participate
that surveys like the one used in this study lend
themselves to recall bias as clinicians are responding to hypothetical scenarios versus what
they actually do

Conclusions

There is significant variability in opinions

regarding the ef-ficacy and optimal route
of administration of GCs for many
laryngeal diseases.
There is little literature to guide
otolaryngologists in their decision
making for this patient population.
Randomized studies investigating GC
use for laryngeal disorders may help to
establish better guidelines for GC
therapy