Studying the effect of inhaled corticosteroids on the larynx in bronchial asthma patients using videostroboscopy

Abstract

EnAbstract Introduction The frequent use of inhaled corticosteroids (ICS), especially at higher doses, has been accompanied by concern about both systemic and local side effects. The systemic complications of ICS have been extensively studied and are well documented in the literature. There are comparatively few studies reporting on the local complications of ICS. Compared with systemic side effects, the local side effects of ICS are considered to constitute infrequent and minor problems. However, although not usually serious, these local side effects are of clinical importance. Aim of the work The aim of this study was to demonstrate the effect of ICS on the larynx using videostroboscopy in patients suffering from bronchial asthma in order to avoid these effects on the patients in further protocols of treatment. Patients and methods This study was carried out on 50 patients suffering from bronchial asthma. They were divided into two groups. Group A included 25 patients suffering from bronchial asthma treated using ICS (budesonide) for 1 year at a dose of 1600 μg/day. Group B included 25 patients having bronchial asthma and not receiving ICS. Each patient was subjected to the following protocols of assessment: (i) elementary diagnostic procedures such as (a) patient interviews, (b) auditory perceptual assessment, and (c) laryngeal visualization. (ii) Clinical diagnostic aids: laryngovideostroboscopy was carried out using a digitalized stroboscopy system to examine the vocal fold mobility, congestion, hypertrophy, ventricular folds hypertrophy, glottic gap, and glottic closure. The following acoustic parameters were measured: fundamental frequency, jitter (cycle-to-cycle variation in frequency), shimmer (cycle-to-cycle variation in amplitude), and noise-to-harmonic ratio (N/H). (iii) Additional instrumental diagnostic measures: the acoustic signals were recorded from each patient. The results of this study revealed more laryngeal abnormalities in group A than in group B. Dysphonia was found in 76% of the patients in group A, in which voice was perceived as either strained, leaky, or of rough qualities. The following changes in the glottis were observed in some patients: either localized or diffuse congestion of the vocal folds, hypertrophy in the ventricular bands, incomplete glottic closure, and glottic gap. In addition, there were also decreases in glottic wave and amplitude. Acoustic analysis showed significant increase in the jitter and shimmer values.