Anticholinergic Use Is a Major Risk Factor for Chronic Laryngitis

Abstract

Objectives: Dysphonia in the setting of chronic laryngitis is a common complaint within an otolaryngology practice. Often, the exact causes are poorly understood. We hypothesize that much of the laryngitis is a form of sicca caused by anticholinergic medication use and aimed to determine their association. Methods: A case-control study evaluating 185 patients presenting to a laryngology practice was conducted over an 8 week period. Patients with a chief complaint of hoarseness secondary to chronic laryngitis rated a variety of symptoms (hoarseness, throat clearing, cough, post-nasal drip, globus sensation) on a scale of 1-5. Controls had few to no symptoms of laryngitis. After controlling for subjects with known causes of laryngitis, laryngitis scores were compared with subjects’ medication lists, age, and gender, and then evaluated using logistic regression via odds ratios (OR), with confidence intervals set at 95%. Results: Any patient taking at least one anticholinergic medication had a 3.86 increased odds (confidence interval [CI] 1.18-12.60) of experiencing chronic laryngitis. If the patient was taking 2 or more anticholinergic medications, those odds rose to 7.94 (CI 1.88-33.50). Polypharmacy was also an independent risk factor for chronic laryngitis (OR 4.46, CI 1.49-13.07), while increasing age potentiated this risk. Conclusions: This is the first study to our knowledge that implicates medication use as a major risk factor, and possible cause, of chronic laryngitis. The striking association with anticholinergic use suggests that much laryngitis is due to sicca, or a drying effect. An awareness of this important association is invaluable when attributing cause to chronic laryngitis and considering treatment options.