The Role of Steroids in Vocal Care
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An emotional and (as usual) honest Billie Eilish took to the stage to accept an award, tearfully stating "I'm on prednisone... I've had no voice all week, laryngitis, and I'm on prednisone... last time I was on it I threw my phone and shattered a mirror and this time, I will be crying."
With her typical candor and openness, she described what is usually quietly whispered about though widely accepted - performers often use prednisone and other steroids to help their voices.
What are steroids and why do singers use them?
Steroids come in many varieties. All serve to decrease inflammation, including laryngitis that interferes with performance voice.
prednisone - a pill usually prescribed for 5 days
dexamethasone - the "butt shots" often given backstage for quick "fixes"
methylprednisolone - a pill pack that has a built-in taper
etc...
These emergency medications are often used for performances when the artist has an issue that is causing vocal swelling. Swollen vocal cords create abnormal vibrations which results in a raspy voice. Singers will notice a loss of vocal range, pitchiness, and difficulty with mixed voice. Actors will notice texture in their voices and keynoters often feel voice fatigue and may lose their voices completely throughout a speech.
In these scenarios, steroids provide temporary improvement; however, steroids come with risks.
Risks of steroid use short-term (<5 days)
immunosuppression - the body is less able to fight infection
increased anxiety or irritability, mood symptoms
stomach irritation
retained fluid/bloating, weight gain
insomnia
vocal injury*
*When vocal rest is required but, instead, steroids are used to help with performance, vocal injuries can occur. This includes vocal bruising, polyp, or nodule formation.
Risks of steroid use long-term
osteoporosis and bone fractures
elevated blood sugar/diabetes
glaucoma and cataracts
high blood pressure
stomach ulcers
skin changes (stretch marks, etc)
suppression of the natural production of steroid hormones in the body (like cortisol)*
*This can happen even with shorter-term use, which is why steroids are often tapered to allow the body to begin to produce its steroid hormones again
It's important to recognize that an inability to sing without relying on steroids indicates an underlying problem. Temporary relief from swelling from steroids does not address more severe issues such as pre-nodules, nodules, cysts, or other vocal masses. Steroids might mask the symptoms, but these masses persist and can worsen over time, often necessitating surgery. The same risks exist with steroid shots and IVs.
When there are vocal issues, a proper vocal exam including videostroboscopy is critical to determining if symptoms are due to inflammation, early injury, or bruising. Depending on findings, steroids may be indicated or may mask a serious injury.
With accurate identification and treatment of underlying issues, many singers may find that they no longer need steroids. Seeking the guidance of a laryngologist is the key to determining a vocally healthy strategy for performance.
References
Hodgens A, Sharman T. Corticosteroids. StatPearls.
