Laryngitis is

inflammation Inflammation (from ) is part of the biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. The five cardinal signs are heat, pain, redness, swelling, and loss of function (Latin ''calor'', '' ...

of the

larynx The larynx (), commonly called the voice box, is an organ (anatomy), organ in the top of the neck involved in breathing, producing sound and protecting the trachea against food aspiration. The opening of larynx into pharynx known as the laryngeal ...

(voice box). Symptoms often include a hoarse voice and may include

fever Fever or pyrexia in humans is a symptom of an anti-infection defense mechanism that appears with Human body temperature, body temperature exceeding the normal range caused by an increase in the body's temperature Human body temperature#Fever, s ...

, 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 Smoking is a practice in which a substance is combusted, and the resulting smoke is typically inhaled to be tasted and absorbed into the bloodstream of a person. Most commonly, the substance used is the dried leaves of the tobacco plant, whi ...

tuberculosis Tuberculosis (TB), also known colloquially as the "white death", or historically as consumption, is a contagious disease usually caused by ''Mycobacterium tuberculosis'' (MTB) bacteria. Tuberculosis generally affects the lungs, but it can al ...

allergies Allergies, also known as allergic diseases, are various conditions caused by hypersensitivity of the immune system to typically harmless substances in the environment. These diseases include Allergic rhinitis, hay fever, Food allergy, food al ...

, acid reflux,

rheumatoid arthritis Rheumatoid arthritis (RA) is a long-term autoimmune disorder that primarily affects synovial joint, joints. It typically results in warm, swollen, and painful joints. Pain and stiffness often worsen following rest. Most commonly, the wrist and h ...

, or

sarcoidosis Sarcoidosis (; also known as Besnier–Boeck–Schaumann disease) is a disease involving abnormal collections of White blood cell, inflammatory cells that form lumps known as granulomata. The disease usually begins in the lungs, skin, or lymph n ...

. The underlying mechanism involves irritation of the

vocal cords In humans, the vocal cords, also known as vocal folds, are folds of throat tissues that are key in creating sounds through Speech, vocalization. The length of the vocal cords affects the pitch of voice, similar to a violin string. Open when brea ...

Diagnosis

Concerning signs that may require further investigation include

stridor Stridor () is an extra-thoracic high-pitched breath sound resulting from turbulent air flow in the larynx or lower in the bronchial tree. It is different from a stertor, which is a noise originating in the pharynx. Stridor is a physical sig ...

, history of

radiation therapy Radiation therapy or radiotherapy (RT, RTx, or XRT) is a therapy, treatment using ionizing radiation, generally provided as part of treatment of cancer, cancer therapy to either kill or control the growth of malignancy, malignant cell (biology), ...

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 Laryngoscopy () is endoscopy of the larynx, a part of the throat. It is a medical procedure that is used to obtain a view, for example, of the vocal folds and the glottis. Laryngoscopy may be performed to facilitate tracheal intubation during ge ...

. Other conditions that can produce similar symptoms include epiglottitis,

croup Croup ( ), also known as croupy cough, is a type of respiratory infection that is usually caused by a virus. The infection leads to swelling inside the trachea, which interferes with normal breathing and produces the classic symptoms of "bar ...

, inhaling a

foreign body A foreign body (FB) is any object originating outside the body of an organism. In machinery, it can mean any unwanted intruding object. Most references to foreign bodies involve propulsion through natural orifices into hollow organs. Foreign b ...

, and

laryngeal cancer Laryngeal cancer is a kind of cancer that can develop in any part of the larynx (voice box). It is typically a squamous-cell carcinoma, reflecting its origin from the epithelium of the larynx. The prognosis is affected by the location of the tumo ...

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.

Antibiotic An antibiotic is a type of antimicrobial substance active against bacteria. It is the most important type of antibacterial agent for fighting pathogenic bacteria, bacterial infections, and antibiotic medications are widely used in the therapy ...

s 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 Dysphagia is difficulty in swallowing. Although classified under " symptoms and signs" in ICD-10, in some contexts it is classified as a condition in its own right. It may be a sensation that suggests difficulty in the passage of solids or l ...

(difficulty swallowing) * Sensation of swelling in the area of the

(discomfort in the front of the neck) * Globus pharyngeus (feeling like there is a lump in the throat) * Cold or

flu-like symptoms Influenza-like illness (ILI), also known as flu-like syndrome or flu-like symptoms, is a medical diagnosis of possible influenza or other illness causing a set of common symptoms. These include fever, shivering, chills, malaise, dry cough, loss ...

(which, like a cough, may also be a causal factor for laryngitis) * Swollen

lymph node A lymph node, or lymph gland, is a kidney-shaped organ of the lymphatic system and the adaptive immune system. A large number of lymph nodes are linked throughout the body by the lymphatic vessels. They are major sites of lymphocytes that includ ...

s in the throat, chest, or face * Fever * General muscle pain (

myalgia Myalgia or muscle pain is a painful sensation evolving from muscle tissue. It is a symptom of many diseases. The most common cause of acute myalgia is the overuse of a muscle or group of muscles; another likely cause is viral infection, espec ...

) *

Shortness of breath Shortness of breath (SOB), known as dyspnea (in AmE) or dyspnoea (in BrE), is an uncomfortable feeling of not being able to breathe well enough. The American Thoracic Society defines it as "a subjective experience of breathing discomfort that con ...

, 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. They may also have breathier voices, as more air flows through the space between the vocal folds (the

glottis The glottis (: glottises or glottides) is the opening between the vocal folds (the rima glottidis). The glottis is crucial in producing sound from the vocal folds. Etymology From Ancient Greek ''γλωττίς'' (glōttís), derived from ''γ ...

), 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

* Most acute cases of laryngitis are caused by viral infections, the most common of which tend to be

rhinovirus The rhinovirus (from the "nose", , romanized: "of the nose", and the ) is a Positive-sense single stranded RNA virus, positive-sense, single-stranded RNA virus belonging to the genus ''Enterovirus'' in the family ''Picornaviridae''. Rhinoviru ...

influenza virus ''Orthomyxoviridae'' () is a family of negative-sense RNA viruses. It includes nine genera: '' Alphainfluenzavirus'', '' Betainfluenzavirus'', '' Gammainfluenzavirus'', '' Deltainfluenzavirus'', '' Isavirus'', '' Mykissvirus'', '' Quaranjavir ...

, parainfluenza virus,

adenovirus Adenoviruses (members of the family ''Adenoviridae'') are medium-sized (90–100 nm), nonenveloped (without an outer lipid bilayer) viruses with an icosahedral nucleocapsid containing a double-stranded DNA genome. Their name derives from t ...

coronavirus Coronaviruses are a group of related RNA viruses that cause diseases in mammals and birds. In humans and birds, they cause respiratory tract infections that can range from mild to lethal. Mild illnesses in humans include some cases of the comm ...

, and respiratory syncytial virus ( RSV). In patients who have a compromised immune system, other viruses such as herpes and human immunodeficiency virus (HIV) may also be potential causes.

Bacterial

* This is another major cause of acute laryngitis, and it may develop in conjunction with or due to a bacterial infection. Common bacterial strains are group A streptococcus, ''

Streptococcus pneumoniae ''Streptococcus pneumoniae'', or pneumococcus, is a Gram-positive, spherical bacteria, hemolysis (microbiology), alpha-hemolytic member of the genus ''Streptococcus''. ''S. pneumoniae'' cells are usually found in pairs (diplococci) and do not f ...

'', '' C. diphtheriae'', '' M. catarrhalis'', ''

Haemophilus influenzae ''Haemophilus influenzae'' (formerly called Pfeiffer's bacillus or ''Bacillus influenzae'') is a Gram-negative, Motility, non-motile, Coccobacillus, coccobacillary, facultative anaerobic organism, facultatively anaerobic, Capnophile, capnophili ...

'', '' Bordetella pertussis'', ''

Bacillus anthracis ''Bacillus anthracis'' is a gram-positive and rod-shaped bacterium that causes anthrax, a deadly disease to livestock and, occasionally, to humans. It is the only permanent (obligate) pathogen within the genus ''Bacillus''. Its infection is a ty ...

'',, and '' M. tuberculosis''. In developing countries, more unusual bacterial cases may occur, such as

mycobacterial ''Mycobacterium'' is a genus of over 190 species in the phylum Actinomycetota, assigned its own family, Mycobacteriaceae. This genus includes pathogens known to cause serious diseases in mammals, including tuberculosis ('' M. tuberculosis'') an ...

and syphilitic, though these may occur in developed nations as well.

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. Patients with both functioning and impaired immune systems can develop fungal laryngitis, which may develop as a result of recent antibiotic or inhaled corticosteroids use. Certain strains of fungi that may cause laryngitis include, '' Histoplasma'', '' Blastomyces'', ''Candida'' (especially in immunocompromised persons), ''

Cryptococcus ''Cryptococcus'' is a genus of fungi in the family Cryptococcaceae that includes both yeasts and filamentous species. The filamentous, sexual forms or teleomorphs were formerly classified in the genus ''Filobasidiella'', while ''Cryptococcus' ...

,'' and '' Coccidioides''.

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. Another potential cause of inflammation may be overuse of the vocal cords. Laryngeal trauma, including

iatrogenic Iatrogenesis is the causation of a disease, a harmful complication, or other ill effect by any medical activity, including diagnosis, intervention, error, or negligence." Iatrogenic", ''Merriam-Webster.com'', Merriam-Webster, Inc., accessed 27 ...

(caused by

endotracheal intubation Tracheal intubation, usually simply referred to as intubation, is the placement of a flexible plastic tube into the trachea (windpipe) to maintain an open airway or to serve as a conduit through which to administer certain drugs. It is frequently ...

), 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. Some researchers have posited that allergic causes of laryngitis are often misdiagnosed as being the result of acid reflux.

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. According to a meta-analysis by Silva et al. (2007), this disease is often an uncommon cause of laryngeal symptoms and is frequently misdiagnosed as another voice disorder.

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

hoarseness A hoarse voice, also known as dysphonia or hoarseness, is when the voice involuntarily sounds breathy, raspy, or strained, or is softer in volume or lower in pitch. A hoarse voice can be associated with a feeling of unease or scratchiness in the ...

. The symptoms in this form of laryngitis are usually present for less than 1 week, however they can persist for 3–4 weeks. This form of laryngitis might also be accompanied by upper respiratory tract symptoms such as sore throat,

odynophagia Odynophagia is pain when swallowing. The pain may be felt in the mouth or throat and can occur with or without difficulty swallowing. The pain may be described as an ache, burning sensation, or occasionally a stabbing pain that radiates to the ...

rhinorrhea Rhinorrhea (American English), also spelled rhinorrhoea or rhinorrhœa (British English), or informally runny nose is the free discharge of a thin mucus fluid from the nose; it is an extremely common condition. It is a common symptom of allergie ...

dyspnea Shortness of breath (SOB), known as dyspnea (in AmE) or dyspnoea (in BrE), is an uncomfortable feeling of not being able to breathe well enough. The American Thoracic Society defines it as "a subjective experience of breathing discomfort that ...

, postnasal discharge, and congestion. * Fungal laryngitis: A

biopsy A biopsy is a medical test commonly performed by a surgeon, interventional radiologist, an interventional radiologist, or an interventional cardiology, interventional cardiologist. The process involves the extraction of sampling (medicine), sample ...

and culture of an abnormal lesion may help confirm fungal laryngitis.

Visual diagnosis

The larynx itself will often show

erythema Erythema (, ) is redness of the skin or mucous membranes, caused by hyperemia (increased blood flow) in superficial capillaries. It occurs with any skin injury, infection, or inflammation. Examples of erythema not associated with pathology inc ...

(reddening) and

edema Edema (American English), also spelled oedema (British English), and also known as fluid retention, swelling, dropsy and hydropsy, is the build-up of fluid in the body's tissue (biology), tissue. Most commonly, the legs or arms are affected. S ...

(swelling). This can be seen with

or stroboscopy (method depends on the type of laryngitis). Stroboscopy may be relatively normal or may reveal asymmetry, aperiodicity, and reduced mucosal wave patterns. Text was copied from this source, which is available under
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: * Difficulty swallowing * Vocal

* Ear pain * Recent weight loss * History of smoking * Current or recent radiotherapy treatment (in the neck region) * Recent neck surgery or surgery involving endotracheal tubing * Person is a professional voice user (teacher, singer, actor, call center worker, etc.)

Differential diagnosis

* Acute epiglottitis: This is more likely in those with

, drooling, and painful or trouble swallowing. * Spasmodic dysphonia * Reflux laryngitis * Chronic allergic laryngitis * Neoplasm *

Croup Croup ( ), also known as croupy cough, is a type of respiratory infection that is usually caused by a virus. The infection leads to swelling inside the trachea, which interferes with normal breathing and produces the classic symptoms of "bar ...

: This presents with a barking cough,

of voice, and inspiratory stridor.

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 (

analgesic An analgesic drug, also called simply an analgesic, antalgic, pain reliever, or painkiller, is any member of the group of drugs used for pain management. Analgesics are conceptually distinct from anesthetics, which temporarily reduce, and in s ...

s), humidification, and antibiotics.

Viral

The suggested treatment for viral laryngitis involves vocal rest,

pain medication An analgesic drug, also called simply an analgesic, antalgic, pain reliever, or painkiller, is any member of the group of drugs used for pain management. Analgesics are conceptually distinct from anesthetics, which temporarily reduce, and in so ...

, 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 An antibiotic is a type of antimicrobial substance active against bacteria. It is the most important type of antibacterial agent for fighting pathogenic bacteria, bacterial infections, and antibiotic medications are widely used in the therapy ...

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,

corticosteroid Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex of vertebrates, as well as the synthetic analogues of these hormones. Two main classes of corticosteroids, glucocorticoids and mineralocorticoids, are invo ...

s, 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: * 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. 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 (

antacid An antacid is a substance which neutralization (chemistry), neutralizes gastric acid, stomach acidity and is used to relieve heartburn, indigestion, or an upset stomach. Some antacids have been used in the treatment of constipation and diarrhe ...

s) and acid suppressants ( H-2 blockers) may be used. Antacids are often short-acting and may not be sufficient for treatment.

Proton pump inhibitors Proton-pump inhibitors (PPIs) are a class of medications that cause a profound and prolonged reduction of gastric acid, stomach acid production. They do so by irreversibly inhibiting the stomach's H+/K+ ATPase, H+/K+ ATPase proton pump. The body ...

are an effective type of medication. These should only be prescribed for a set period of time, after which the symptoms should be reviewed due to significant long-term side effects, such as bone loss. 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 Immunotherapy or biological therapy is the treatment of disease by activating or suppressing the immune system. Immunotherapies designed to elicit or amplify an immune response are classified as ''activation immunotherapies,'' while immunotherap ...

have been found to be effective for

allergic rhinitis Allergic rhinitis, of which the seasonal type is called hay fever, is a type of inflammation in the nose that occurs when the immune system overreacts to allergens in the air. It is classified as a type I hypersensitivity reaction. Signs a ...

Antihistamine Antihistamines are drugs which treat allergic rhinitis, common cold, influenza, and other allergies. Typically, people take antihistamines as an inexpensive, generic (not patented) drug that can be bought without a prescription and provides ...

s 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 Cyclophosphamide (CP), also known as cytophosphane among other names, is a medication used as chemotherapy and to suppress the immune system. As chemotherapy it is used to treat lymphoma, multiple myeloma, leukemia, ovarian cancer, breast cancer ...

and

prednisolone Prednisolone is a corticosteroid, a steroid hormone used to treat certain types of allergies, inflammation, inflammatory conditions, autoimmune disorders, and cancers, Electrolyte imbalance, electrolyte imbalances and skin conditions. Some of ...

Granulomatous

Sarcoidosis Sarcoidosis (; also known as Besnier–Boeck–Schaumann disease) is a disease involving abnormal collections of White blood cell, inflammatory cells that form lumps known as granulomata. The disease usually begins in the lungs, skin, or lymph n ...

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

. The prognosis for chronic laryngitis varies depending on the cause of the laryngitis.

References

External links

Mayo Clinic
{{Authority control Acute upper respiratory infections Human throat Human voice Inflammations Laryngology Voice disorders Wikipedia emergency medicine articles ready to translate Wikipedia medicine articles ready to translate Otorhinolaryngology it:Laringite