Definition and symptoms

Laryngitis is inflammation of the larynx (voice box). Symptoms often include a hoarse voice and may include fever, cough, pain in the front of the neck, and trouble swallowing. Typically, these last under 2 weeks.

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 cords.

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. Antibiotics 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:

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. They may also have breathier voices, as more air flows through the space between the vocal folds (the glottis), quieter volume, and a reduced range.

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. It normally develops in response to either an infection, trauma to the vocal folds, or allergies. Chronic laryngitis may also be caused by more severe problems, such as nerve damage, sores, and polyps, or hard and thick lumps (nodules) on the vocal cords.

Acute

Viral

Bacterial

Fungal

Trauma

Chronic

Allergies

Reflux

Autoimmune disorders

Diagnosis

Diagnosis of different forms of acute laryngitis include:

Visual diagnosis

The larynx itself will often show erythema (reddening) and edema (swelling). This can be seen with laryngoscopy or stroboscopy (method depends on the type of laryngitis). Stroboscopy may be relatively normal or may reveal asymmetry, aperiodicity, and reduced mucosal wave patterns. Other features of the laryngeal tissues may include

Referral

Some signs and symptoms indicate the need for early referral. These include:

Differential diagnosis

Treatment

Treatment is often supportive in nature, and depends on the severity and type of laryngitis (acute or chronic). General measures to relieve symptoms of laryngitis include behavior modification, hydration, and humidification. 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 (analgesics), humidification, and antibiotics.

Viral

The suggested treatment for viral laryngitis involves vocal rest, pain medication, and mucolytics for frequent coughing. Home remedies such as tea and honey may also be helpful. Antibiotics are not used for treatment of viral laryngitis.

Bacterial

Antibiotics may be prescribed for bacterial laryngitis, especially when symptoms of upper respiratory infection are present. However, the use of antibiotics is highly debated for acute laryngitis. This relates to issues of effectiveness, side effects, cost, and possibility of antibiotic resistance patterns. Overall, antibiotics do not appear to be very effective in the treatment of acute laryngitis. In severe cases of bacterial laryngitis, such as supraglottitis or epiglottitis, there is a higher risk of the airway becoming blocked. An urgent referral to a physician should be made to manage the airway. Treatment may involve humidification, corticosteroids, intravenous antibiotics, and nebulised adrenaline.

Fungal

Fungal laryngitis can be treated with oral antifungal tablets and antifungal solutions. These are typically used for up to 3 weeks and treatment may need to be repeated if the fungal infection returns.

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. Behavioral management involves aspects such as: Anti-reflux medications may be prescribed for patients with signs of chronic laryngitis and hoarse voice. If anti-reflux treatment does not result in a decrease of symptoms, other possible causes should be examined. Over-the-counter medications for neutralizing acids (antacids) and acid suppressants (H-2 blockers) may be used. Antacids are often short-acting and may not be sufficient for treatment. Proton pump inhibitors are an effective type of medication. These should only be prescribed for a set period of time, after which the symptoms should be reviewed. Proton pump inhibitors do not work for everyone. A physical reflux barrier (e.g., Gaviscon Liquid) may be more appropriate for some. Antisecretory medications (i.e., ulcers) can have several side-effects. 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. Antihistamines may also be helpful, but can create a dryness in the larynx. Inhaled steroids that are used for a long period can lead to problems with the larynx and voice.

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. Recovery is likely to be quick if the patient follows the treatment plan. In viral laryngitis, symptoms can persist for an extended period, even when upper respiratory tract inflammation has been resolved.

Chronic

Laryngitis that continues for more than 3 weeks is considered chronic. If laryngeal symptoms last for more than 3 weeks, a referral to a physician should be made for further examination, including direct laryngoscopy. The prognosis for chronic laryngitis varies depending on the cause of the laryngitis.