What is Laryngitis? Laryngitis is an inflammation of the larynx due to overuse, irritation or infection. Inside the larynx are the vocal cords. The irritation causes a hoarse voice or the complete loss of the voice.
Normally the vocal cords open and close smoothly. They form sounds through their movement and vibration. In laryngitis, the vocal cords become inflamed or irritated. This swelling causes distortion of the sounds produced by air passing over them. As a result, the voice sounds hoarse. Symptoms of laryngitis include hoarseness, loss of voice, and sore throat.
According to Medilexicon’s medical dictionary:
Laryngitis is “Inflammation of the mucous membrane of the larynx.”
Laryngitis may be short-lived (acute) or long lasting (chronic). Most cases of laryngitis are triggered by a temporary viral infection or vocal strain and are not serious.
The larynx is a tube-like structure found at the entrance of the trachea. The lump at the front of the throat, commonly known as the Adam’s apple, is the larynx. It has three main functions:
It helps channel oxygen into the trachea when breathing.
It acts like a valve, closing off the trachea when swallowing to prevent food or liquid from entering the airways.
It contains two membranes (the vocal cords) which vibrate as air passes through them, producing the sound of the voice.
When these membranes become inflamed, they cannot vibrate properly. This leads to the loss of voice associated with laryngitis.
There are two main types of laryngitis:
Symptoms do not last longer than three weeks. Infection is the most common cause of acute laryngitis. This is usually a viral infection, such as the common cold. Other causes of acute laryngitis include misusing or overusing the voice, for example by shouting or singing too loud. Many professional singers have episodes of acute laryngitis.
Symptoms persist for longer than three weeks. It can be caused by cigarette smoke, alcohol, gastro-esophageal reflux disease (GERD) where acid leaks back up into the throat, environmental factors (dust, fumes and chemicals) and infections.
It is difficult to estimate how common acute laryngitis is because most people do not report their symptoms to their doctor. However, it is thought to be the most common condition to affect the larynx.
Most people will make a full recovery within three weeks without developing complications.
The outlook for chronic laryngitis will depend on the underlying cause. If the condition is due to factors such as smoking or drinking alcohol, the symptoms should get better if the person stops smoking or drinking.
What are the signs and symptoms of laryngitis?
A symptom is something the patient feels and reports, while a sign is something other people, such as the doctor detect. For example, pain may be a symptom while a rash may be a sign.
Symptoms of acute laryngitis can begin suddenly and usually get worse over a period of two to three days. After this time, symptoms should improve. The symptoms of laryngitis include:
a constant need to clear your throat
difficulty breathing (in children)
tickling sensation and rawness of the throat
weak voice or voice loss
swollen lymph glands in the throat, chest, or face
increase production of saliva in the mouth
sensation of swelling in the area of the larynx
Coughing can be a symptom of, or a factor in causing laryngitis. In some cases, people who have laryngitis may not be able to talk at all, or may only be able to whisper or croak. This will usually get worse. It happens because the vocal cords are inflamed.
Laryngitis is often linked to another illness, such as a cold, flu, throat infection or tonsillitis. Therefore, a number of other symptoms may be experienced, such as swollen neck glands, runny nose, pain on swallowing and feeling tired and achy.
Chronic laryngitis takes longer to develop and can last for weeks or even months. It can lead to lasting hoarseness as a result of permanent damage to the larynx. Chronic laryngitis can recur. This is common in people who overuse their voice and are unable to rest their voice for any length of time, such as professional singers or teachers.
Occasionally, swelling of the larynx may cause breathing difficulties. This is not common in adults but can occur in young children who have smaller, narrower windpipes.
Seek medical help if a child experiences difficulty breathing.
What are the causes of laryngitis?
Most cases of laryngitis last less than a few weeks and are caused by something minor. In some cases, laryngitis is caused by something more serious or long lasting.
Most cases of laryngitis are temporary and improve after the underlying cause gets better. Causes of acute laryngitis include:
Viral infections such as a cold or the flu
Vocal strain, caused by yelling or overusing the voice
Viruses such as measles or mumps
Bacterial infections such as diphtheria (rarely)
The varicella-zoster virus (the virus that causes herpes)
Fungal infections, such as thrush (candidiasis) or aspergillosis (rarely)
People with weakened immune systems, due to conditions such as HIV or as a result of treatments such as chemotherapy or steroid medication, are thought to be most at risk from fungal laryngitis.
Prolonged speaking, singing and very loud shouting or signing can cause the vocal cords to vibrate at a faster rate than they should. The excessive vibration can damage the surface of the vocal cords, causing them to become inflamed.
Less common causes of laryngitis include:
direct trauma to the larynx, such as a blow to the throat, an injury sustained during a car accident or a sports injury
persistent and frequent clearing of the throat
Laryngitis that lasts more than three weeks is known as chronic laryngitis. It is generally caused over time by irritants. It can result in vocal cord strain, injuries or growths on the vocal cord. These injuries can be caused by:
Acid reflux, also called gastro esophageal reflux disease (GERD)
Excessive alcohol use. The active ingredient in alcohol (ethanol) contains many impurities that can irritate the larynx.
Regular overuse of the voice
Inhaled irritants, such as chemical fumes, allergens or smoking. Allergic reactions to substances.
Smoking. Persistent exposure to tobacco smoke can cause long-term inflammation of the larynx.
Less common causes of chronic laryngitis include:
Bacterial or fungal infections
Infections with certain parasites
Vocal cord paralysis. It can result from injury, stroke or a lung tumor, or other health conditions.
What are the risk factors of laryngitis?
A risk factor is something which increases the likelihood of developing a condition or disease. For example, obesity significantly raises the risk of developing diabetes type 2. Therefore, obesity is a risk factor for diabetes type 2.
Risk factors for laryngitis include:
Exposure to irritating substances, such as cigarette smoke, excessive alcohol, stomach acid or workplace chemicals
Having a respiratory infection, such as a cold, bronchitis or sinusitis
Overuse of the voice, by speaking too much, speaking too loudly, shouting or singing
When to seek medical advice?
Most acute cases of laryngitis can be managed with self-care steps, such as resting the voice, drinking plenty of fluids, sucking on lozenges, and breathing humidified air.
Seek medical advice if hoarseness lasts for more than two weeks.
Seek medical advice immediately if your child appears to have severe symptoms caused by croup. Croup is the inflammation of the larynx and the airway just beneath it. It can usually be treated at home. Seek immediate medical attention if the child:
Drools more than usual
Has a fever higher than 103 F (39 C)
Has difficulty breathing
Has trouble swallowing
Makes noisy, high-pitched breathing sounds when inhaling
How is laryngitis diagnosed?
Acute laryngitis is usually a condition that will get better by itself without the need for treatment. Therefore, a medical diagnosis is not usually required.
Medical advice may be needed if:
breathing difficulties are experienced
additional symptoms are experienced that suggest there is a more serious infection, such as high temperature (fever) above 38°C (100.4°F) and swollen glands (usually in the neck)
symptoms last for longer than three weeks
If symptoms last for longer than three weeks, lifestyle or occupational factors will be reviewed, such as:
being exposed to potentially allergic substances
Blood tests may be needed as well as taking a small tissue sample from the throat using a swab to check for the presence of a viral, bacterial or fungal infection.
If a reason for the chronic laryngitis cannot be found, there may be referral to an ear, nose and throat (ENT) specialist for further testing.
The ENT specialist may recommend an MRI scan, CT scan and a biopsy (where a sample of tissue is taken to check for the presence of cancerous cells) to rule out laryngeal cancer (cancer of the larynx).
Laryngeal cancer is uncommon. However, it is important to confirm or rule out a diagnosis as soon as possible because the sooner laryngeal cancer is diagnosed, the more effective treatment will be.
Other tests that may be used include:
a skin allergy test to check whether there are allergies to certain substances
chest and neck X-ray to check for any abnormalities, such as an unusual narrowing or swelling of the larynx
laryngoscopy, which is a test where the larynx is examined using a mirror (an indirect laryngoscopy) or a fiber-optic camera (a direct laryngoscopy). This involves inserting a thin, flexible tube (endoscope) with a tiny camera and light through the nose or mouth and into the back of the throat. It can be used to check if the tissue of the larynx has been damaged as a result of gastro-esophageal reflux disease (GERD) or other causes.
A direct laryngoscopy is not painful, but the fiber-optic camera may trigger the gag reflex, which can make someone vomit. To avoid this happening, the procedure is usually performed under sedation or local or general anesthetic.
What is the treatment for laryngitis?
Acute laryngitis usually gets better without treatment within a week. To help vocal cords heal, it is important not to smoke and to avoid smoky environments and follow some recommendations:
Avoid excessive swallowing or coughing because it will irritate vocal cords.
Drink plenty of fluids, particularly water, even though swallowing may be painful. This will avoid dehydration. Avoid alcohol and caffeine.
Gargling with a mouthwash of warm, salty water. Sucking lozenges may help soothe a sore throat. Various gargling solutions are available over-the-counter (OTC) from pharmacies. Gargle for three to four minutes, but do not swallow the solution.
Giving the voice a rest as much as possible. Avoid shouting, singing, talking or whispering for long periods. Overuse of the voice when the vocal cords are swollen may make the inflammation worse. It might take longer for the normal voice to return.
Menthol inhalation and air humidifiers may help to clear the airways.
Most cases of infectious laryngitis are caused by viruses. Antibiotics are not routinely prescribed. If testing shows that that there is a bacterial infection, antibiotics may be prescribed.
Taking painkillers at regular intervals, such as paracetamol, acetaminophen or ibuprofen may ease any symptoms associated headaches and fever. Children under 16 years of age should not take aspirin.
Breathe moist air: Inhale steam from a bowl of hot water or a hot shower.
If laryngitis is due to a bacterial or fungal infection, the patient may be prescribed a course of antibiotics or anti-fungal medication.
The recommended treatment for chronic laryngitis will depend on its underlying cause.
Smoking: Stop smoking if this is causing the symptoms.
Alcohol: If excessive alcohol consumption is irritating the larynx, drink in moderation. The recommended daily alcohol limits are 3 to 4 units of alcohol for men, and 2 to 3 units for women. (A unit is equal to about half a pint of normal strength lager, a small glass of wine (25ml or 0.84 fluid ounces)).
Gastro-esophageal reflux disease: If chronic laryngitis is due to gastro-esophageal reflux disease (GERD), additional treatment may be required to control symptoms. One option for treating GERD is to use proton-pump inhibitors (PPIs). PPIs reduce the amount of acid that is produced by the stomach. The patient may be instructed to take a medication such as Zantac or Prilosec for a period of 4 to 6 weeks.
Allergic reaction: Identify and avoid the specific substance that causes the allergic reaction. However, if this is not possible, antihistamines (a type of anti-allergy medication) can be used to help control an allergic response.
Use of voice: If the chronic laryngitis symptoms are due to misuse or overuse of the voice, vocal therapy may be beneficial. It is a type of speech and language therapy that:
studies how you use your voice
looks at how this may contribute to your symptoms
provides you with information and advice about what changes you can make to prevent further damage to your larynx
Medications used in some cases include:
Corticosteroids. In some cases, corticosteroids can help reduce vocal cord inflammation. However, this treatment is only used when there is an urgent need to treat laryngitis. For instance, when the patient needs to use their voice to sing, give a speech or oral presentation. It may be recommended in some cases when a toddler has laryngitis associated with croup.
To prevent dryness or irritation to the vocal cords:
Do not smoke, avoid secondhand smoke. Smoke dries the throat and irritates the vocal cords.
Drink plenty of water. Fluids help keep the mucus in the throat thin and easy to clear.
Avoid clearing the throat. This can be harmful. It causes an abnormal vibration of the vocal cords and can increase swelling. It also causes the throat to secrete more mucus and feel more irritated, making the person want to clear their throat again.
Avoid upper respiratory infections. Get your annual flu shot if your doctor recommends it. Wash hands often and avoid contact with people who have upper respiratory infections such as colds.
Good personal hygiene. Washing hands before and after eating and after using the toilet.
Avoiding people who are ill, particularly if you are prone to laryngitis.
Avoiding irritants, particularly if you have a cold or other respiratory infection.
Raising the head off the bed with pillows when sleeping. This will protect the larynx from any acid reflux from the stomach during sleep.
Professional singers or people who regularly use their voice excessively are particularly prone to laryngitis and should receive proper training so they do not damage or misuse their voice.
The following self-care tips may ease the symptoms of laryngitis:
Avoid decongestants. These medications can dry out the throat.
Avoid talking or singing too loudly or for too long. When speaking before large groups, try to use a microphone or megaphone.
Avoid whispering. This puts even more strain on your voice than normal speech does.
Give your voice a break. Rest your voice when possible.
Inhale steam. Breathe in steam from a bowl of hot water or a hot shower.
Moisten your throat. By sucking on lozenges, gargling with salt water or chewing a piece of gum.
Use a humidifier. Keep the air moist at home.
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