Laryngitis Disease
BASICS
DESCRIPTION
Inflammation of the mucosa of the larynx. Most common during peaks paralleling epidemics of individual viruses, late fall, winter, early spring. In predisposed individuals may also occur intermittently during period of vocal misuse or abuse. Course may be acute or chronic. Includes atrophic, hypertrophic, reflux, catarrhal, sicca, acute infectious, membranous, granulomatous.
- System(s) affected: Pulmonary
- Genetics: No known genetic pattern
- Incidence/Prevalence in USA: Common
- Predominant age: All ages
- Predominant sex: Male = Female
SIGNS AND SYMPTOMS
- Hoarseness
- Abnormal sounding voice
- Aphonia or dysphasia
- Throat tickling
- Feeling of throat rawness
- Constant urge to clear the throat
- Fever
- Malaise
- Dysphagia
- Throat pain
- Cough
- Regional lymphadenopathy
- Stridor in children
CAUSES
- Virus infections - influenza A, B, parainfluenza, adenovirus, coronavirus, rhinovirus, HPV, CMV, HSV
- Bacterial infections - beta-hemolytic streptococcus, Streptococcus pneumoniae, H. influenza, tuberculosis, leprosy, Moraxella catarrhalis
- Misuse or abuse of voice
- Inhaling irritating substances (eg, air pollution)
- Aspiration of caustic chemical
- Aging changes - muscle atrophy, loss of moisture in larynx, bowing of vocal cords
- Esophageal reflux
- Fungal infections
- Parasites
- Spirochetes (syphilis)
- Allergic
- Autoimmune
- Idiopathic
- Vocal cord nodules/polyps
- Injury or compression of recurrent laryngeal nerve
- Retropharyngeal abscess
- Tumor
RISK FACTORS
- Acute
- Upper respiratory tract infection
- Bronchitis
- Pneumonia
- Influenza
- Pertussis
- Measles
- Diphtheria
- Immunocompromised
- Chronic
- Allergy
- Chronic rhinitis
- Chronic sinusitis
- Voice abuse
- Reflux of gastric contents
- Smoking
- Alcohol abuse
- Constant exposure to dust or other irritants
DIAGNOSIS
LABORATORY
WBC elevated in bacterial laryngitis
Drugs that may alter lab results: N/A
Disorders that may alter lab results: N/A
PATHOLOGICAL FINDINGS
N/A
SPECIAL TESTS
Virus culture (seldom necessary)
IMAGING
Only if needed for differential diagnosis
DIAGNOSTIC PROCEDURES
- Fiberoptic or indirect laryngoscopy - red, inflamed and occasionally hemorrhagic vocal cords, with rounded edges, and exudate
- Consider otolaryngologic evaluation and biopsy - laryngitis of greater than 2 weeks in adults with history of smoking or alcohol abuse
- Consider 24° pH probe - chronic laryngitis in adults with gastroesophageal reflux
TREATMENT
APPROPRIATE HEALTH CARE
Outpatient
GENERAL MEASURES
- Acute
- Usually a self-limited illness and not severe
- Vocal conservation without excessive voice use
- Steam inhalations or cool-mist humidifier
- Increase fluid intake
- Analgesics
- Avoid smoking (or cigarette smoke from others) during acute phase
- Chronic
- Symptomatic treatment as above
- Voice therapy (for patients with intermittent dysphagia and vocal abuse)
- Stop smoking
- Reduce alcohol intake
- Occupational change or modification, if exposure
- For reflux laryngitis - elevate head of bed, other antireflux management
- Consider otolaryngology consultation for:
- Hoarseness > 2-3 weeks
- Hoarseness associated with hemoptysis, difficulty swallowing or breathing, or a lump in neck
- Loss or severe voice change for more than a few days
SURGICAL MEASURES
- Vocal cord biopsy of hyperplastic mucosa and areas of leukoplakia if cancer is suspected
- Removal of nodules or polyps if voice therapy fails
ACTIVITY
Rest until fever subsides then, no restrictions
DIET
No special diet
PATIENT EDUCATION
- Provide assistance with smoking cessation
- Help patient with modification of other predisposing habits or occupational hazards
FOLLOW UP
PREVENTION/AVOIDANCE
- Avoid overuse of voice
- Prompt treatment of respiratory infections
- Influenza virus vaccine for high-risk individuals
- Quit smoking
- Avoid alcohol and caffeine
- Maintain proper hydration status
POSSIBLE COMPLICATIONS
Chronic hoarseness
EXPECTED COURSE AND PROGNOSIS
Complete clearing of the inflammation without sequelae
MISCELLANEOUS
ASSOCIATED CONDITIONS
- Viral pharyngitis
- Croup
- Bronchitis
- Pneumonitis
AGE-RELATED FACTORS
Pediatric: Common in this age group
Geriatric: May be sicker and slower to heal
Others: N/A
PREGNANCY
Use only safe antibiotics, if antibiotics are essential
OTHER NOTES
N/A
ABBREVIATIONS
N/A
Clinical Investigations
- Cardiology
- Dermatology
- General Destistry
- Cardiology
- Dermatology
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