Correspondence (reply): In Reply

Sharing his clinical experience, our colleague Professor Schoen has highlighted the important fact that temporary, reversible hoarseness can occur after administration of (systemic) glucocorticoids. In a recently published study, 12% of these patients experienced temporary hoarseness, presumably due to vocal fold edema (1). Interestingly, we also found that this side effect is not mentioned in the Red List, in contrast to hoarseness associated with inhaled corticosteroid (ICS) therapy (2).

We would like to thank our colleagues Dr. Thomas and Professor Dazert for their comments. In their letter they point out that malignancy should be ruled out in any patient with unexplained hoarseness within one month, regardless of the presence or absence of risk factors. In contrast to the US guideline cited in our article, which recommends immediate laryngoscopy only in patients with risk factors (3), they are calling for indirect laryngoscopy to be performed within a timeframe of no more than 4 weeks after the onset of hoarseness, with reference to an expert survey among members of the American Laryngological Association, the American Broncho-Esophagological Association and the European Laryngological Society (4). It is needless to say that the school of thought at our department is that any unexplained hoarseness should be investigated by an ETN specialist using indirect laryngoscopy within a period of 4 weeks. Unfortunately, our selective search of the pertinent literature on this topic (2) identified only the evidence-based guideline of Schwartz et al. from the United States (3). The authors recommend to immediately perform laryngoscopy in patients with suspected serious underlying disease or with dysphonia of more than 3 months’ duration (3). That is where the dilemma lies: there are no evidence-based randomized controlled trials available evaluating when laryngoscopy should be performed in patients with hoarseness and this shortcoming also applies to treatment concepts. Regrettably, no specific German-language S3 guideline has (yet) been published; thus, we have to mostly rely on expert opinions. In this respect, we still have a number of challenges lying ahead of us.