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Laryngitis - Causes, Symptoms and Treatment


A common disorder, laryngitis is acute or chronic inflammation of the vocal cords and is characterized by hoarseness. Acute laryngitis may occur as an isolated infection or as part of a generalized bacterial or viral upper respiratory tract infection. Repeated attacks of acute laryngitis cause inflammatory changes associated with chronic laryngitis.

Causes of Laryngitis

Acute laryngitis usually results from infection (primarily viral) or excessive use of the voice, an occupational hazard in certain vocations (teaching, public speaking, singing), and occasionally allergy (hay fever). It may also result from leisure-time activities (such as cheering at a sporting event), inhalation of smoke or fumes, or aspiration of caustic chemicals. It may also be associated with group A streptococcus and Moraxella catarrhalis. Causes of chronic laryngitis include chronic upper respiratory tract disorders (sinusitis, bronchitis, nasal polyps, allergy); mouth breathing; smoking; constant exposure to dust or other irritants; and alcohol abuse.

Tuberculosis may also cause a form of laryngitis, and may be mistaken for laryngeal cancer. In this case, fever and night sweats are possible symptoms, with chest radiography revealing apical thickening and fibrosis. Biopsy reveals granulomas with acid-fast bacilli. The diagnosis is confirmed by culture and sensitivity testing.

Fungal infections causing laryngitis include histoplasmosis, blastomycosis, and candidiasis in immunocompromised patients or in those with chronic mucocutaneous candidiasis.

Signs and Symptoms of Laryngitis

Acute laryngitis typically begins with hoarseness, ranging from mild to complete loss of voice. Associated clinical features include pain (especially when swallowing or speaking), dry cough, fever, laryngeal edema, and malaise. In chronic laryngitis, persistent hoarseness is usually the only symptom. In reflux laryngitis, hoarseness and dysphagia are present but heartburn is not.

Diagnosis for Laryngitis

The initial work-up and evaluation of the patient with hoarseness is guided by the chronicity of the condition, so a comprehensive history is essential, as is examination of the larynx. Indirect laryngoscopy with a head light and a warmed laryngeal mirror provides the quickest and best view of the hypopharynx and larynx. This may be difficult for the primary care provider, so referral to otolaryngology may be necessary. Hoarseness lasting more than 3 weeks without a history of acute infection warrants referral and further evaluation.

Indirect laryngoscopy confirms the diagnosis by revealing red, inflamed and, occasionally, hemorrhagic vocal cords, with round, rather than sharp, edges and exudate. Bilateral swelling may be present.In severe cases, or if toxicity is a concern, a culture of the exudate is obtained.

Other pertinent physical examination includes the oropharynx, thyroid, and cervical lymph nodes. If there is an unexplained neck mass or suspicious lymph node, careful evaluation may include assessment of thyroid-stimulating hormone if hypothyroidism is suspected, and small­needle biopsy of any questionable mass.

The differential diagnosis of hoarseness should be evaluated in terms of acute and chronic etiologies. Acute hoarseness differential diagnoses include acute laryngitis, acute laryngeal edema, and acute epiglottitis. Chronic hoarseness may point to chronic laryngitis (such as vocal abuse, allergy), laryngeal carcinoma, lesions of the vocal cords, trauma to the vocal cords, systemic disease (such as hypothyroidism, rheumatoid arthritis, vitalization), or psychogenic disorder.

Treatment for Laryngitis

Primary treatment consists of resting the voice. When required to speak, the patient should use a moderate voice and not whisper. Hot tea with sugar and lemon may be helpful. For viral infection, symptomatic care includes analgesics and throat lozenges for pain relief. Humidity (such as a hot steam shower, or breathing through a hot, moist towel) may also be beneficial. Occasionally, a vasoconstricting spray and analgesics are used by professionals when use of their voice is absolutely necessary. Bacterial infection requires antibiotic therapy. Severe, acute laryngitis may necessitate hospitalization. When laryngeal edema results in airway obstruction, tracheotomy may be necessary. In chronic laryngitis, effective treatment must eliminate the underlying cause. In reflux laryngitis, postural and dietary changes along with antacids and H 2 antagonists combine for effective treatment.

Special Considerations and Prevention Tips for Laryngitis

  • Minimize the need to talk by trying to anticipate the patient's needs.
  • Urge him to complete the course of prescribed antibiotics.
  • Obtain a detailed patient history to help determine the cause of chronic laryngitis. Encourage modification of predisposing habits.
  • Suggest that the patient maintain adequate humidification by using a vaporizer or humidifier during the winter and by avoiding air conditioning during the summer (because it dehumidifies). Suggest using medicated throat lozenges.
  • If pertinent, all patients with hoarseness who smoke or chew tobacco should be strongly encouraged to quit.

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