Definition

Within the larynx lie the vocal cords, comprised of muscles and cartilage covered by mucous membranes. Laryngitis denotes inflammation of the larynx due to factors such as excessive use of the vocal cords, irritation, or infection. During speaking, the vocal cords open and close to produce sound. In cases of laryngitis, these cords become inflamed, leading to swelling. This swelling hampers the airflow through the vocal cords, disrupting sound production, and resulting in the typical symptom of hoarseness. In severe instances, laryngitis can cause a very faint or absent voice altogether, known as aphonia.

Laryngitis is classified into two types: acute, which arises suddenly, and chronic, persisting for an extended period. Acute laryngitis usually resolves within 7 days, while chronic laryngitis may persist for over 3 weeks. In many cases, viral infections are the cause of laryngitis, while chronic laryngitis often stems from more serious medical conditions.

Causes

Laryngitis can be triggered by infectious and non-infectious factors, including exposure to harmful substances, trauma, allergies, and medication use.

Acute laryngitis

Acute laryngitis commonly stems from:

• Viral infections: Rhinovirus infections are frequent culprits, alongside parainfluenza virus, respiratory syncytial virus (RSV), influenza, and adenovirus.
• Excessive use of the vocal cords: Practices such as extensive singing, shouting, or prolonged speaking.
• Bacterial infections: Although rare, Moraxella catarrhalis, Haemophilus influenzae, and Streptococcus aureus can cause acute laryngitis.

Chronic laryngitis

Chronic laryngitis, lasting beyond 3 weeks, typically results from prolonged exposure to irritants, vocal cord injury, or the growth of masses on the vocal cords. Common causes include:

• Inhaled irritants: Chemicals, allergens, or smoke.
• Gastroesophageal reflux disease (GERD).
• Chronic sinusitis.
• Long-term alcohol use.
• Occupations necessitating extensive voice use, such as singing or teaching.
• Smoking.
• Bacterial or fungal infections (rare).
• Parasitic infections (rare).
• Masses: Either cancerous or benign tumors.
• Vocal cord nodules (singer's nodes), are commonly observed in singers.
• Vocal cord paralysis, stemming from surgery, trauma, cancer, nerve disorders, or other health conditions.

Risk factor

Risk factors for laryngitis encompass:

• Prior upper respiratory tract infections (URTI).
• Incomplete or missed vaccinations, notably for Hib, diphtheria, and BCG vaccines.
• Exposure to irritants: Smoking, excessive alcohol consumption, gastric acid, or hazardous workplace chemicals.
• Excessive vocal cord use: Overuse, such as prolonged talking, shouting, or singing.
• Weak immune system (e.g., HIV).
• Use of inhaled corticosteroids, heightening the risk of candida laryngitis.

Symptoms

Symptoms of laryngitis include:

• Hoarse voice.
• Reduced volume or loss of voice (aphonia).
• Itchy or lump sensation in the throat.
• Throat pain.
• Dry throat.
• Dry cough.

Diagnosis

Your doctor will inquire about your symptoms, including when you started experiencing them, your main complaints, and any risk factors such as respiratory infections, smoking, or occupation-related exposures. They will also assess your medical history, including conditions like GERD. Hoarseness is a common symptom reported by patients with laryngitis.

Your doctor will also evaluate your general condition. In some cases, patients may present with unstable conditions, such as with diphtheria or epiglottitis, which can cause airway obstruction requiring immediate management.

If laryngitis is suspected, your doctor may refer you to an ENT specialist for further examination, which may include:

• Laryngoscopy: This procedure involves directly visualizing the condition of your larynx. A small camera is inserted through your mouth or nose so that your doctor can assess the condition of your vocal cords both at rest and during speech.
• Stroboscopy: This test evaluates vocal cord function, voice quality, and helps distinguish between benign and malignant masses, such as cancer.
• Biopsy: If a mass is suspected as the cause of laryngitis, a biopsy may be performed to determine its type.

Management

The approach to managing laryngitis varies based on its type and underlying cause. If laryngitis stems from overuse of the vocal cords, the initial step often involves resting your voice. Typically, refraining from speaking for a day allows your voice to recover.

Antibiotics are typically unnecessary for acute laryngitis, as it is usually viral in nature. Instead, your doctor may prescribe medications like pain relievers, mucolytics, and cough suppressants to alleviate symptoms.

In cases of chronic laryngitis, addressing the root cause is essential for symptom relief. For instance, if gastric acid reflux is the culprit, your doctor may recommend lifestyle adjustments and prescribe antacid medications until symptoms abate.

Self-care at home

You can do the following to take care of yourself at home while experiencing laryngitis symptoms:

• Ensure indoor air is humid by using a humidifier.
• Rest your voice as much as possible. Do not talk too much and too loudly. If you need to use your voice, you can use a microphone.
• Consume 6-8 glasses of water per day.
• Limit caffeine and alcohol consumption.
• Avoid throat clearing too often.

Complications

Acute laryngitis often resolves with rest and hydration, with viral infections rarely causing complications. Bacterial infections may lead to scar tissue formation on the vocal cords. In chronic laryngitis, complications can arise from untreated underlying conditions.

Prevention

Laryngitis can be prevented by ensuring the throat remains moist and avoiding irritation. Steps you can take include:

• Quit smoking and avoid exposure to smoke. Cigarette smoke can dry out the throat, making it more prone to irritation.
• Limit alcohol and caffeine consumption. Alcohol and caffeine can decrease body water levels, affecting the moisture of the mucous membranes of the vocal cords. Dry vocal cords are more prone to irritation.
• Drink plenty of water. Consuming 6-8 glasses of water per day can help thin mucus in the throat, making it easier to clear.
• Limit spicy foods. Spicy foods can trigger acid reflux. Exposure to gastric acid can irritate the vocal cords and cause chronic laryngitis.
• Consume a healthy and varied diet including fruits, vegetables, and grains. These foods contain vitamins that play a role in your health.
• Maintain personal hygiene to avoid upper respiratory tract infections (URTI) by regularly washing your hands.
• Practice vocal exercises in moderation. If you have to perform, take breaks to prevent swelling of your vocal cords.

When to see a doctor?

Symptoms of laryngitis can be managed at home by practicing self-care steps. Using your vocal cords when experiencing laryngitis can worsen the condition and damage your vocal cords. Consult your doctor if your laryngitis symptoms persist for more than 2 weeks.

Visit the emergency room (ER) immediately if you experience laryngitis symptoms accompanied by:

• Difficulty breathing
• Coughing up blood
• Persistent fever not improving with medication
• Increased throat pain

Take your child to the emergency room (ER) immediately if they experience:

• High-pitched or noisy breathing (stridor) when inhaling
• Excessive drooling
• Difficulty swallowing
• Difficulty breathing
• Fever