The study evaluated 118 patients seen at Saint Marys Hospital, one of Mayo Clinic’s two hospitals, in Rochester, Minn., between August 1998 and July 2000 who complained of a sore throat. Each patient was asked to rate their pain on a scale of one to 10. A throat culture was obtained and every patient was given a course of antibiotics. In addition, some were given a single dose of steroid, dexamethasone, either in a shot or a pill form, while others were given a placebo (a sugar pill or saline shot with no medicinal value) in pill or injection form. Neither the physician nor patient knew if they were given the steroid or the placebo.
Patients were asked to rate their pain in 12 hours and again in 24 hours from the time of treatment (dexamethasone has a half-life of approximately 12 to 24 hours in the body). The researchers found that the patients given the steroid reported pain relief four hours sooner, and eventually rated the relief as twice that reported by those given placebos.
Sore throats and colds are among the most common reasons people visit their doctor, and they are the main reason antibiotics are prescribed in emergency rooms. Each year, sore throats account for more than $300 million in health care spending, according to the U.S. Department of Health. An estimated 80 million outpatient visits per year to physicians in the United States are related to upper respiratory tract dysfunction (sore throats that cause problems with breathing, eating and drinking). Typically, two-and-a-half working days are lost with each visit. This brings the total cost nationwide to more than $1.3 billion a year, or approximately 10 percent of the annual health care cost in the United States.
Among those patients given the steroid, 67 percent returned to normal activity in 12 hours and 84 percent returned to normal activity in 24 hours. Of the patients given the placebo, 33 percent returned to normal activity in 12 hours and 50 percent were back to normal after 24 hours.
There was no significant difference between the pill and the shot. However, Mayo Clinic recommends the pill form of steroid. There are little to no costs associated with administering the pill, whereas a shot requires that a physician or nurse be available to give it. No one in the study complained of any side effects.
A team of researchers led by Julie Wei, M.D., a former Mayo Clinic ear, nose and throat physician resident; Andrew Boggust, M.D., a Mayo Clinic emergency medicine specialist; Jan Kasperbauer, M.D., a Mayo Clinic ear, nose and throat specialist and Amy Weaver, M.S., a Mayo Clinic biostatistician, initially observed how effectively steroids decrease nausea, vomiting and throat pain in children the day after they have their tonsils removed. Dr. Wei noted the children also were able to swallow food sooner after taking steroids.
"Studies have shown that steroids take away pain in children who have just had tonsillectomies," says Dr. Wei. We thought we could apply the same principle to sore throat. The team reasoned that steroids also might help reduce sore throat. Patients with pharyngitis may experience difficulty with breathing and swallowing, resulting in dehydration and increasing the number of hospital visits. The team of researchers noted that steroids have been effectively used in emergency room settings for treatment of asthma, bacterial meningitis, cerebral edema, acute spinal cord injury and acute allergic reactions.
Contact:
Sara Bakken
507-284-5005 (days)
507-284-2511 (evenings)
e-mail: newsbureau@mayo.edu
Journal
The Laryngoscope