Laryngitis is inflammation of the larynx (voice box).
Causes
Laryngitis is categorized as acute if it lasts less than 3 weeks and chronic if symptoms last more than 3 weeks.
Acute cases usually occur as part of a viral upper respiratory tract infection,
other infections, and trauma such as from coughing or other causes.
Chronic cases may occur due to
smoking,
tuberculosis,
allergies,
acid reflux, rheumatoid arthritis, or
sarcoidosis.
The underlying mechanism involves irritation of the
vocal folds.
Diagnosis
Concerning signs that may require further investigation include
stridor, history of radiation therapy to the neck, trouble swallowing, duration of more than 3 weeks, and a history of smoking.
If concerning signs are present. the vocal cords should be examined via
laryngoscopy.
Other conditions that can produce similar symptoms include
epiglottitis,
croup, inhaling a
foreign body, and
laryngeal cancer.
Treatment and epidemiology
The acute form of the infection, or acute laryngitis, generally resolves without specific treatment.
Resting the voice and sufficient fluids may help.
generally do not appear to be useful in the acute form.
The acute form is common while the chronic form of the infection, or chronic laryngitis, is not.
Chronic laryngitis occurs most often in middle age and is more common in men than women.
Signs and symptoms
The primary symptom of laryngitis is a hoarse voice.
Because laryngitis can have various causes, other signs and symptoms may vary.
They can include:
-
Dry or sore throat
-
Coughing (both a causal factor and a symptom of laryngitis)
-
Frequent throat clearing
-
Increased saliva production
-
Dysphagia (difficulty swallowing)
-
Sensation of swelling in the area of the larynx (discomfort in the front of the neck)
-
Globus pharyngis (feeling like there is a lump in the throat)
-
Cold or flu-like symptoms (which, like a cough, may also be a causal factor for laryngitis)
-
Swollen in the throat, chest, or face
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Fever
-
General muscle pain (myalgia)
-
Dyspnea, predominantly in children
Voice quality
Aside from a hoarse-sounding voice, changes to pitch and volume may occur with laryngitis. Speakers may experience a lower or higher pitch than normal, depending on whether their vocal folds are swollen or stiff.
Causes
Laryngitis can be infectious as well as noninfectious in origin. The resulting inflammation of the vocal folds results in a distortion of the sound produced there.[ ]
Acute
Viral
-
Most acute cases of laryngitis are caused by viral infections,
Bacterial
-
This is another major cause of acute laryngitis, and it may develop in conjunction with or due to a bacterial infection.
Fungal
-
Laryngitis caused by fungal infection is common but not frequently diagnosed according to a review by BMJ and can account for up to 10% of acute laryngitis cases.
Trauma
-
Trauma is often due to excessive use of the vocal folds such as by yelling, screaming, or singing. Though this often results in damage to the outer layers of the vocal folds, the subsequent healing process may lead to changes in the physiology of the folds.
[ ][ ][ ][ ][ ] Laryngeal trauma, including iatrogenic (caused by endotracheal intubation), can also result in inflammation of the vocal cords.
Chronic
Allergies
-
Findings are unclear as to whether asthma may cause symptoms commonly associated with laryngitis.
Reflux
-
One possible explanation of chronic laryngitis is that inflammation is caused by gastro-esophageal reflux, which causes subsequent irritation of the vocal folds.
Autoimmune disorders
-
Between approximately 30 and 75% of persons with rheumatoid arthritis report symptoms of laryngitis.
-
Symptoms of laryngitis are present in only 0.5–5% of people that have sarcoidosis.
Diagnosis
Diagnosis of different forms of acute laryngitis include:
-
Laryngitis following trauma: This form of laryngitis is usually identified by obtaining a case history providing information on previous phono-traumatic experiences, internal trauma caused by recent procedures as well as any previous neck injuries.
-
Acute viral laryngitis: This form of laryngitis is characterized by lower vocal pitch as well as Hoarse voice.
-
Fungal laryngitis: A biopsy and culture of an abnormal lesion may help confirm fungal laryngitis.
Visual diagnosis
The larynx itself will often show erythema (reddening) and edema (swelling). This can be seen with laryngoscopy or Stroboscope (method depends on the type of laryngitis).[ Text was copied from this source, which is available under a Creative Commons Attribution 4.0 International License.]
Other features of the laryngeal tissues may include
-
Redness of the laryngeal tissues (acute)
-
Dilated blood vessels (acute)
-
Thick, yet dry laryngeal tissue (chronic)
-
Stiff vocal folds
-
Sticky secretions between the vocal folds and nearby structures (the interarytenoid region)
Referral
Some signs and symptoms indicate the need for early referral.[ These include:
]
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Difficulty swallowing
-
Vocal stridor
-
Ear pain
-
Recent weight loss
-
History of smoking
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Current or recent radiotherapy treatment (in the neck region)
-
Recent neck surgery or surgery involving Tracheal tube
-
Person is a professional voice user (teacher, singer, actor, call center worker, etc.)
Differential diagnosis
-
Acute epiglottitis: This is more likely in those with stridor, drooling, and painful or trouble swallowing.
-
Spasmodic dysphonia
[
]
-
Reflux laryngitis
[
]
-
Chronic allergic laryngitis
[
]
-
Neoplasm
[
]
-
Croup: This presents with a barking cough, Hoarse voice of voice, and Stridor.
Treatment
Treatment is often supportive in nature, and depends on the severity and type of laryngitis (acute or chronic).
Vocal hygiene (care of the voice) is very important to relieve symptoms of laryngitis. Vocal hygiene involves measures such as resting the voice, drinking sufficient water, reducing caffeine and alcohol intake, stopping smoking, and limiting throat clearing.
Acute laryngitis
In general, acute laryngitis treatment involves vocal hygiene, painkillers (), humidification, and antibiotics.[
]
Viral
The suggested treatment for viral laryngitis involves vocal rest, Analgesic, and mucolytics for frequent coughing.
Bacterial
Antibiotics may be prescribed for bacterial laryngitis, especially when symptoms of upper respiratory infection are present.[
]
In severe cases of bacterial laryngitis, such as supraglottitis or epiglottitis, there is a higher risk of the airway becoming blocked.
Fungal
Fungal laryngitis can be treated with oral antifungal tablets and antifungal solutions.
Trauma
Laryngitis caused by excessive use or misuse of the voice can be managed through vocal hygiene measures.
Chronic laryngitis
Reflux
Laryngopharyngeal reflux treatment primarily involves behavioral management and medication.
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Wearing loose clothing
-
Eating smaller, more frequent meals
-
Avoiding certain foods (e.g., caffeine, alcohol, spicy foods)
Anti-reflux medications may be prescribed for patients with signs of chronic laryngitis and hoarse voice.
When appropriate, anti-reflux surgery may benefit some individuals.
Inflammatory
When treating allergic laryngitis, topical nasal steroids and immunotherapy have been found to be effective for allergic rhinitis.
Autoimmune
Mucous membrane pemphigoid may be managed with medication (cyclophosphamide and prednisolone).
Granulomatous
Sarcoidosis is typically treated with systemic corticosteroids. Less frequently used treatments include intralesional injections or laser resection.
Prognosis
Acute
Acute laryngitis may persist, but will typically resolve on its own within 2 weeks.
Chronic
Laryngitis that continues for more than 3 weeks is considered chronic.
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