2018 Section 6 - Laryngology, Voice Disorders, and Bronchoesophalogy

Reprinted by permission of Acta Otolaryngol. 2016; 136(7):699-702.

ACTA OTO-LARYNGOLOGICA, 2016 VOL. 136, NO. 7, 699–702 http://dx.doi.org/10.3109/00016489.2016.1146409

RESEARCH ARTICLE

Effect of inhaled steroids on laryngeal microflora

Mahfuz Turan a , Selami Ekin b , R ı fk ı Ucler c , Ahmet Ar ı soy b , Yasemin Bayram d , Abdulaziz Yal ı nk ı l ı c¸ a , Naz ı m Bozan a , Mehmet Fatih Garca a and Hakan C¸ ankaya a a Department of Otorhinolaryngology, Yuzuncu Yil University Faculty of Medicine, Van, Turkey; b Department of Chest Disease, Yuzuncu Yil University Faculty of Medicine, Van, Turkey; c Department of Endocrinology and Metabolism, Yuzuncu Yil University Faculty of Medicine, Van, Turkey; d Department of Medical Microbiology, Yuzuncu Yil University Faculty of Medicine, Van, Turkey

ABSTRACT Conclusions As is known, this study is the first study to evaluate the effect of inhaled steroids on laryngeal microflora. The data support that ICS usage causes changes in the larynx microflora. Purpose The aim of this study was to determine the alteration in larynx microbial flora of the patients treated with ICS comparing the culture results of a control group. In addition, laryngeal microflora was compared to the smears obtained from the vallecula and pharynx. Materials and methods The study included 39 patients (mean age ¼ 45.56 12.76 years) who had been using a corticosteroid inhaler and control group consisting of 27 persons (mean age ¼ 43.07 13.23 years). Culture samples were obtained from the pharynx, larynx, and vallecula in the patient and control groups, and they were evaluated in the microbiology laboratory. Obtained culture results were named by the same microbiologist according to the basic microorganism classification method. Results Coagulase-negative staphylococci (CNS), Streptococcus viridians (VGS) and candida albicans were detected to grow significantly more in the patient group in all three anatomic localizations compared to the control group. Neisseria spp , basillus spp , and Non-viridans alpha-hemolytic streptococcus were detected to grow significantly more in the control group in all three anatomic localizations compared to the patient group.

ARTICLE HISTORY Received 17 November 2015 Revised 12 January 2016 Accepted 17 January 2016

Published online 18 February 2016

KEYWORDS Inhaled steroids; microflora; larynx

Introduction Asthma is a chronic inflammatory disease of the airways with changeable airflow occlusion, that is frequently reversible but may be incomplete in some patients. The basic characteristic of asthma is intermittent airway obstruction caused usually by airway inflammation. In spite of the attainability of today’s treatment choices for asthma, many patients survive symp- tomatic and may experience asthma exacerbations [ 1 ]. Anti- inflammation therapy with inhaled corticosteroids (ICS) is the first line treatment [ 1 ]. Inhaled corticosteroids (ICS) are related to lesser side-effects in comparison with oral steroids [ 2 ]. The most common local adverse effects of inhaled corticosteroid therapy have been reported to be candidiasis and dysphonia [ 3 ]. In patients with dysphonia, if it is severe, the only remedy is discontinuation of the inhaled corticosteroid treatment [ 3 ]. The rate of dysphonia with corticosteroid treatment has been reported to vary from 8–58% [ 4 ]. There is limited knowledge on the effect of steroid inhaler usage on laryngeal microflora in the literature. Thus, the aim of this study was to determine the alteration in larynx microbial flora of the patients treated with ICS comparing the culture results of the control group. In addition, laryngeal microflora was compared with the smears obtained from the vallecula and pharynx.

Materials and methods Subjects

This prospective study was conducted between the dates of March 2013 and January 2014. A total of 39 patients (mean age ¼ 45.56 12.76 years) who had been using a corticosteroid inhaler due to chronic asthma during a minimum 1-year period, were included in the study. Laryngeal symptoms are not present in subjects. The control group included 27 cases (mean age ¼ 43.07 13.23 years) with no detected pathological finding following laryngoscopy, which was performed due to non-specific complaints such as hoarseness or feeling of stuck throat, with no known chronic disease or drug usage history. The study was approved by the ethical committee of Yu¨zu¨ncu¨ Yl University Medical Faculty (No: 21–14.02.2013). All the patients were informed about the study, and written consents were obtained. The study group were used to dry powder inhalers (DPIs), including Discus , Aerolizer , and Turbohaler without a spacer. The patients were informed about characteristics of the ICS (formulation, daily dose, type of inhaler, and duration of use), as well as about the practice of oral hygiene after ICS use. The practice of oral hygiene was considered correct when the patients rinsed their mouths with water immediately after ICS use, gargled, and subsequently spat out the wash water.

CONTACT Mahfuz Turan, MD mahfuzturan@hotmail.com Yuzuncu Yil University, Faculty of Medicine, Department of Otorhinolaryngology, 65080, Van, Turkey 2016 Taylor & Francis

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