Dysphonia

Generally, inhaled glucocorticoids have few side effects, the appearance of which depends on the dose, the frequency of administration, and the delivery system used. The most common side effect is dysphonia (hoarseness), which affects approximately one third of treated patients. Oropharyngeal candidiasis (thrush)... 

Local adverse effects of inhaled corticosteroids include oral candidiasis and dysphonia. The incidence of local adverse... 

Monitor for adverse events from medications, including candidiasis and dysphonia from inhaled corticosteroids. 

Assess the patient for adverse effects, particularly candidiasis and dysphonia associated with inhaled corticosteroids. 

Gastrointestinal diarrhea, nausea, vomiting Respiratory shortness of breath, progressing to paralysis Cardiovascular arrythmias, hypertension or hypotension Neurologic paresthesias of mouth and lips, weakness, dysphasia, dysphonia... 

The onset of botulism occurs generally between 18 and 36 hours after consumption of food products containing botulin toxin. However, it may affect patients earlier or later, even on the tenth day after food consumption. The first symptoms include stomach ache, nausea, vomiting, and diarrhea, followed by neurological disorders. Other symptoms include, skin, mouth and throat dryness, diplopia, blurred vision, dysphonia, dysarthria, dysphagia, and peripheral weakness. In lethal cases of botulism, respiratory muscles are involved. This leads to respiratory failure and death. Because all the symptoms are connected with toxemia, the first step of medical treatment is to provide a patient with antiserum. 

Local Throat irritation hoarseness/dysphonia, coughing dry mouth rash wheezing facial edema flu syndrome. 

Fluticasone - Adverse reactions occurring in 3% or more of patients include headache pharyngitis nasal congestion sinusitis rhinitis upper respiratory tract infection influenza oral candidiasis diarrhea dysphonia menstrual disturbance nasal discharge allergic rhinitis fever. 

Fluticasone, Nasal (Flonase) [Anti inflammotory/Corticos-teroid] Uses Seasonal all gic rhinitis Action Topical st oid Dose Adults Feds >12 y. 2 sprays/nostril/d Feds 4-11 y. 1-2 sprays/nostril/d Caution [C, M] Contra Primary Rx of status asthmaticus Disp Nasal spray meg SE HA, dysphonia, oral candidiasis Interactions t Effects ketoconazole EMS May... 

Uses Mild-mod asthma Action Anti-inflammatory agent Dose Inhal 2 inhal qid Caution [B, /-] Contra Component allergy Disp Met-dose inhal SE Chest pain, dizziness, dysphonia, rash, GI upset, Infxn EMS Not for acute asthma, use an inhaled [3-agonist OD Unlikely... 

ICS (Inhaled Corticosteroids) Indications Cough, dysphonia, oral thrush... 

Rinse mouth with water following INH to decrease possibility of fungal infections, dysphonia... 

The local adverse effects of inhaled glucocorticoids have been studied in a prospective, cross-sectional, cohort study in 639 asthmatic children using beclomethasone (721 micrograms/day) or budesonide (835 micrograms/ day) for at least one month (28). The local adverse effects included cough (40%), thirst (22%), hoarseness (14%), dysphonia (11%), oral candidiasis (11%), perioral dermatitis (2.9%), and tongue hypertrophy (0.1%). A spacer doubled the incidence of coughing. 

A local myopathy caused by inhaled glucocorticoids can also cause dysphonia. However, patients with asthma have more dysphonia and vocal fold pathology than healthy controls and inhaled glucocorticoids can improve the voice in some patients (SEDA-21,188). 

Laryngeal disorders (vocal fold granuloma, ventricular dysphonia, mutational dysphonia)... 

An 18-year-old man was found collapsed outside the nightclub. He had taken five ecstasy tablets and some powder that was later confirmed as ecstasy. He was vomiting and agitated, had a tachycardia and hyperthermia, and needed mechanical ventilation. He later developed rhabdomyolysis and renal impairment with raised liver enzymes. He went on to develop pneumonia and a urinary tract infection. He was discharged after 32 days with a mildly ataxic gait and dysphonia secondary to vocal cord damage. 

Other pediatric signs of mustard exposure were photophobia, lacrimation, ophthalmalgia, and eye burning (94%). Dry cough (81%), dermal pain, and burning (94%) were also frequent complaints. Less frequent complaints were diplopia, itchy eyes, sore throat, sneezing, nasal secretions, dyspnea, burning sensation of the upper respiratory tract, suffocation, and dysphonia (Azizi and Amid, 1990). 

Cordeiro MF, Arnold KG. Digoxin toxicity presenting as dysphagia and dysphonia. BMJ 1991 302(6783) 1025. 

A 45-year-old woman developed extensive urticarial lesions 30 minutes after the application of a hair dye, starting on the scalp and face, followed by abdominal cramps, watery diarrhea, vomiting, dysphonia, and loss of consciousness. A prick test with a 1/128 dilution of the hair dye showed a positive reaction, but individual dye constituents did not. Prick testing with the oxidation products of the individual dye constituents showed a strongly positive reaction to oxidized paratoluenediamine, which was weaker after addition of an antioxidant to the mixture. 

A 40-year-old male nurse developed facial angioedema, dyspnea, rhinoconjunctivitis, dysphonia, and dysphagia immediately after opening a sachet containing amoxicillin and clavulanic acid (149). Skin prick tests were positive for both amoxicillin and ampicillin, and an open test with amoxicillin resulted in a severe immediate-type reaction with large localized wheals and erythema at 10 minutes. Six months later, when he was asymptomatic, erythema was observed during open tests with ampicillin 5%. 

A 42-year-old patient presented with generalized pruritus, erythema, urticaria, facial angioedema, dysphagia, dysphonia, and dizziness 15 minutes after a single intramuscular dose of pethidine 100 mg for severe renal colic (15). Prick tests and intradermal tests with pethidine and other compounds confirmed an allergic reaction to pethidine. 

There was also an arm treated with inhaled fluticasone alone. Outcome variables were peak flow and asthma symptoms. Both combination and concurrent therapy with fluticasone plus salmeterol resulted in significantly better symptom control and higher peak flows than fluticasone alone. There were no significant differences in the effects of fluticasone plus salmeterol delivered in a combination inhaler versus separate inhalers. Drug-related adverse effects were similar in all three treatment groups most were asthma-related, but hoarseness, dysphonia, and throat irritation were the commonest adverse effects attributed to therapy (1-4%). 

The effects of salmeterol 50 micrograms plus fluticasone 250 micrograms delivered via a combination inhaler and via separate inhalers have been compared in 371 asthmatic patients (18). There were equivalent improvements in peak flows and asthma sjmptoms. Candidiasis, dysphonia, and throat irritation were the commonest adverse effects attributed to treatment and occurred equally in the two groups (35%). Palpitation and tremor, which may have been related to salmeterol, occurred in 2% (for each symptom) of the combination group and in 1% and under 1% of the separate inhaler group. In both of these studies compliance was measured by dose counters on the inhalers and was equivalent in the two groups. 

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