Laryngitis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Anthony Gallo, B.S. [2]

Laryngitis is an inflammation of the larynx. It causes a hoarse voice or the complete loss of the voice because of irritation to the vocal folds (vocal cords). Laryngitis is categorized as acute if it lasts less than a few days.^[1] Otherwise, it is categorized as chronic and may last over 3 weeks.

Laryngitis is an ancient disease. In 1840, Dr. Jordan Roche Lynch, an English physician, published a case study on the treatment of acute laryngitis.^[2] In 2005, Drs. Reveiz, Cardona, and Ospina demonstrated that antibiotics were not effective in the treatment of laryngitis.^[3]

Based on the duration of symptoms, laryngitis may be classified into either acute or chronic.^[4] Generally, acute laryngitis has an abrupt onset and is self-limiting; typically, it clears within 3-5 days.^[5] Chronic laryngitis may be defined as lasting greater than 3 weeks.^[6]

The voice box (larynx) is located at the top of the airway to the lungs (trachea). The larynx contains the vocal cords. When the vocal cords become inflamed or infected, they swell. This can cause hoarseness, and may sometimes block the airway.

Laryngitis may be the result of infectious or noninfectious causes. The most common causes of laryngitis are due to viral infections, and include rhinovirus, adenovirus, influenza virus, parainfluenza virus, and respiratory syncytial virus. Common bacterial causes of laryngitis include Staphylococcus aureus and Haemophilus influenzae.

Laryngitis must be differentiated from upper respiratory tract infection, vocal fold cyst, nodule, or polyp, and laryngeal stenosis.

Acute laryngitis commonly affects children. Women are more commonly affected with laryngitis than men.^[7] The incidence of laryngitis in the winter is double that of the summer.^[8]

Common risk factors in the development of laryngitis include upper respiratory infection, asthma, and cigarette smoke.

Screening for laryngitis is not recommended.

If left untreated, generally acute laryngitis will naturally resolve between 3-7 days.^[9] Common complications of laryngitis include mild throat pain. Prognosis for laryngitis is generally excellent; there is no known mortality rate.

Symptoms of laryngitis include hoarseness, cough, and swollen lymph nodes.^[10][11]

Patients with laryngitis usually appear well. Physical examination of patients with laryngitis is usually remarkable for vocal fold cyst, vocal fold nodules, and swollen lymph nodes in the neck.^[12][13]

There are no diagnostic lab findings associated with laryngitis.

There are no electrocardiogram findings associated with laryngitis.

There are no x ray findings directly associated with laryngitis. On x ray of the neck, supraglottic or retropharyngeal swelling, unusual narrowing, or soft tissue density in subglottic airway may be observed.^[14]

There are no CT findings directly associated with laryngitis. CT may be ordered when pathology outside of the larynx is suspected.^[15]

There are no MRI findings directly associated with laryngitis. MRI may be ordered when pathology outside of the larynx is suspected.^[16]

Laryngoscopy is indicated when hoarseness lasts longer than two weeks and does not have an apparent benign cause; this can occur via direct or indirect laryngoscopy.^[12][17][18]

There is no treatment for viral laryngitis; the mainstay of therapy is supportive care. The mainstay of therapy for infectious causes of laryngitis is antimicrobial therapy. Medical therapy for laryngitis due to gastroesophageal reflux includes acid suppression therapy such as either omeprazole or ranitidine.

Surgery is not the first-line treatment option for patients with laryngitis. Surgery is usually reserved for patients with persistent laryngitis due to vocal cord nodules.^[19][20]

Effective measures for the primary prevention of laryngitis include avoidance of people with upper respiratory infections, hand washing, and smoking cessation.^[21][22]

Effective measures for the secondary prevention of laryngitis include avoidance of throat clearing, increased fluid intake, and limit vocal cord usage.^[8][22]

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Anthony Gallo, B.S. [2]

Laryngitis is an ancient disease. In 1840, Dr. Jordan Roche Lynch, an English physician, published a case study on the treatment of acute laryngitis.^[1] In 2005, Drs. Reveiz, Cardona, and Ospina demonstrated that antibiotics were not effective in the treatment of laryngitis.^[2]

• Laryngitis is an ancient disease.
• In 1840, Dr. Jordan Roche Lynch, an English physician, published a case study on the treatment of acute laryngitis.^[1] This case study appears to be the oldest accessible finding of laryngitis in Western literature, however, it appears the disease had been well studied prior.
• In 2005, Drs. Reveiz, Cardona, and Ospina demonstrated that antibiotics were not effective in the treatment of laryngitis.^[2]

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Anthony Gallo, B.S. [2]

Based on the duration of symptoms, laryngitis may be classified into either acute or chronic.^[1]

Based on the duration of symptoms, laryngitis may be classified into either acute or chronic.^[1] Generally, acute laryngitis has an abrupt onset and is self-limiting; typically, it clears within 3-5 days.^[2] Chronic laryngitis may be defined as lasting greater than 3 weeks.^[3]

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Anthony Gallo, B.S. [2]

The voice box (larynx) is located at the top of the airway to the lungs (trachea). The larynx contains the vocal cords. When the vocal cords become inflamed or infected, they swell. This can cause hoarseness, and may sometimes block the airway.

• Laryngitis is the result of an immunological sequelae to an infection, generally an upper respiratory viral infection.
• During an infection, activated antigen-presenting cells, such as macrophages, present the antigen to helper T cells.
  • Helper T cells subsequently activate B cells and induce the production of antibodies against the virus.
• The antibodies may also act against the affected larynx, producing the symptoms of laryngitis.^[1]

• There are no genetic predispositions to the development of laryngitis.

• Laryngitis is associated with upper respiratory infections, which include common cold, influenza, pharyngitis, tracheitis, bronchitis, and epiglottitis.

On gross pathology, redness, swollen cords, and purulent discharge are characteristic findings of laryngitis.

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On microscopic histopathological analysis, polymorphonuclear neutrophils are characteristic findings of laryngitis.

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ogheneochuko Ajari, MB.BS, MS [2], Anthony Gallo, B.S. [3]

Laryngitis may be the result of infectious or noninfectious causes. The most common causes of laryngitis are due to viral infections, and include rhinovirus, adenovirus, influenza virus, parainfluenza virus, and respiratory syncytial virus. Common bacterial causes of laryngitis include Staphylococcus aureus and Haemophilus influenzae.

Life-threatening causes of laryngitis include anthrax. Life-threatening causes may result in death or permanent disability within 24 hours if left untreated.

Common causes of laryngitis include:

• Adenovirus
• Haemophilus influenzae
• Herpes zoster
• Influenza
• Measles
• Mumps
• Parainfluenza virus
• Respiratory syncytial virus
• Rhinovirus
• Staphylococcus aureus

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Anthony Gallo, B.S. [2]

Laryngitis must be differentiated from upper respiratory tract infection, vocal fold cyst, nodule, or polyp, and laryngeal stenosis.

Laryngitis must be differentiated from other diseases and conditions which cause inflammation near the larynx. These include:^{[1][2][3][4][5][6]}

• Upper respiratory tract infection
• Vocal fold cyst, nodule, or polyp
• Laryngeal stenosis
• Spasmodic dysphonia
• Post-nasal drip (chronic upper airway cough syndrome)
• Contact granulomas
• Glottic stenosis
• Thyroarytenoid muscle sulcus
• Reinke’s edema
• Epiglottitis
• Foreign body obstruction
• Subglottic stenosis
• Angioneurotic edema
• Retropharyngeal abscess
• Bacterial tracheitis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Anthony Gallo, B.S. [2]

Acute laryngitis commonly affects children. Women are more commonly affected with laryngitis than men.^[1] The incidence of laryngitis in the winter is double that of the summer.^[2]

• Acute laryngitis commonly affects children.
• The prevalence of laryngitis decreases with age.
• In 2011, the incidence of laryngitis was estimated to be approximately 6 cases per 100,000 individuals in the United Kingdom.^[3]
• In 2012, approximately 839,000 children (1.4%) reported a voice problem in the 12 months; approximately half of had received a diagnosis, with laryngitis being the most common.^[4]

Women are more commonly affected with laryngitis than men.^[1]

The incidence of laryngitis in the winter is double that of the summer.^[2]

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Anthony Gallo, B.S. [2]

Common risk factors in the development of laryngitis include upper respiratory infection, asthma, and cigarette smoke.

Common risk factors in the development of laryngitis include:^[1][2][3][4]

• Upper respiratory infection
• Asthma
• Cigarette smoke
• Polluted air
• Winter season
• Young age
• Autoimmune disorders, such as rheumatoid arthritis and sarcoidosis
• Overactive vocal activity
• Gastroesophageal reflux disease (GERD)

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Anthony Gallo, B.S. [2]

Screening for laryngitis is not recommended.

Screening for laryngitis is not recommended.

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Anthony Gallo, B.S. [2]

If left untreated, generally acute laryngitis will naturally resolve between 3-7 days.^[1] Common complications of laryngitis include mild throat pain. Prognosis for laryngitis is generally excellent; there is no known mortality rate.

If left untreated, generally acute laryngitis will naturally resolve between 3-7 days. Acute cases which progress to chronic conditions are generally associated with rare pathogen.^[1]

Common complications of laryngitis include mild throat pain. Rare complications of acute laryngitis include vocal cord damage and severe respiratory distress. Rare complications of chronic laryngitis include aphonia, chronic cough, and laryngeal stenosis.^[2]

Prognosis for laryngitis is generally excellent; there is no known mortality rate.