Laryngitis overview

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]