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Drug-induced vocal cord damage

Some drugs induce vocal cord damage.

The vocal cords are soft mucosal folds with fibrous muscles and ligaments, whose vibration, produced by the passage of air from the lungs, produces the voice. When the vocal cords are damaged, the symptoms most often observed are: dysphonia (modified sounds), pain, hoarseness, croakiness, lowering of the voice tone. Sometimes these symptoms hinder communication and affect a person’s social life.

Voice disorders are most often linked to overuse of the vocal cords or more rarely to lesions of the mucosa including inflammation, infection, polyps and neurological disorders.

Some toxins expose the vocal cords to damage, including tobacco, alcohol, sulphuric acid, dust, or welding smoke.

Drugs induce vocal cord damage by various mechanisms: mucosal deposits, mucosal dryness and reduced vocal cord lubrication, changes in salivary composition, oedema, erythema, necrosis, or mucosal haematomas, paralysis of the vocal cords.

Drug-induced vocal cord damage can appear within a few hours or a few months. Halting the drug treatment generally results in healing, within a few hours or up to several months.

These drugs are mainly inhaled corticosteroids, antimuscarinics (antiparkinsonian, antihistamine, etc.), sympathomimetics (pseudoephedrine), androgens, antihypertensives, NSAIDs, antithrombotics, anticoagulants, neuroleptics, antitumour and anti-VEGF drugs.

Patients exposed to a drug known to cause damage to the vocal cords need to be informed of this adverse effect, especially when it is irreversible (androgenic drugs) or if they use their voice extensively. 

©Prescrire 1 January 2018

"Drug-induced vocal cord disorders" Prescrire Int 2018; 27 (189): 13-17. (Pdf, subscribers only).

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