Laryngitis refers to inflammation of the larynx and can present in both acute and chronic form. Acute Laryngitis is a mild and self-limiting condition that typically lasts for a period of 3 to 7 days. If this condition lasts for over 3 weeks, then it is termed as chronic laryngitis. The acute form of laryngitis is more common among both.
The etiology for acute laryngitis can be classified as infectious and non-infectious. The infectious form is more common and usually follows the upper respiratory tract infection. To begin with, it is usually viral but soon bacterial agents supervene. Viral agents include Rhinovirus, Parainfluenza virus, Respiratory Syncytial virus, coronavirus, adenovirus, influenza virus. Coxsackievirus and HIV may be potential causes among immunocompromised individuals. Most commonly encountered bacterial organisms are Streptococcus pneumoniae, H.influenzae, and Moraxella catarrhalis. Exanthematous fevers like measles, chickenpox and whooping cough are also associated with acute laryngitis. Laryngitis caused by fungal infection is also common but frequently remains undiagnosed. This usually occurs secondary to use of inhaled corticosteroids or recent antibiotic use. trains causing fungal laryngitis includehHistoplasma, blastomyces, candida, cryptococcus and coccidioides
The non-infectious form is due to vocal trauma, allergy, gastroesophageal reflux disease, use of asthma inhalers, environmental pollution, smoking and thermal or chemical burns of the larynx.
In addition, the patients with rhinitis are more prone to develop laryngitis.
Acute laryngitis usually affects individuals aged 18 to 40 years of age. However, it may be seen in children as young as 3 years of age or above. Accurate figures regarding the incidence of acute laryngitis remain unknown as this condition remains unreported most of the times. Since its a self-limiting disease, significant morbidity and mortality are not encountered.
An acute form of laryngitis resolves within 2 weeks. Infectious form is characterized by congestion of larynx in early stages. As the healing stage begins, white blood cells invade at the site of infection to remove the pathogens. This process enhances vocal cord edema and affects vibration adversely. As the edema progresses phonation threshold pressure increases. Generation of adequate phonation pressure becomes difficult, and the patient develops hoarseness. Sometimes edema is so marked that it becomes impossible to generate adequate phonation pressure. In such a situation, the patient develops frank aphonia.
Vocal Trauma induced acute laryngitis usually occurs following excessive screaming or singing. This results in damage to the outer layer of the vocal fold. However, repeated episodes may cause fibrosis and scarring at a later stage.
Initial symptoms are those of upper respiratory tract infection and include fever, cough, sore throat and rhinorrhoea. Following this, acute laryngitis sets in. Symptoms are usually abrupt in onset and get worsened over two or three days. These include:
Diagnosis can usually be made based on history.
Local Examination of larynx further confirms the diagnosis. Indirect examination of the airway with a mirror and direct examination with a flexible nasolaryngoscope is used for examination. Laryngeal appearances vary with the severity of the disease. In the early stages there is erythema and edema of the epiglottis, aryepiglottic folds, arytenoids, and ventricular bands, but vocal cords, in contrast, are normal and white, betraying the degree of hoarseness the patient has. As the disease progresses, vocal cords also turn red and edematous. The subglottic region may also get involved. Sticky secretions may also be seen between vocal cords and interarytenoid region. In case of vocal abuse, submucosal hemorrhage may also be seen in vocal cords.
Diagnosis is usually made clinically only. Fiberoptic or indirect laryngoscopy further confirms the diagnosis. Stroboscopy reveals asymmetry, aperiodicity, and reduced mucosal wave pattern. Further imaging or laboratory studies are not required. Rarely, if the patient has exudate in the oropharynx or vocal cords, culture may be sent.
Treatment is often supportive in nature and depends on the severity of laryngitis.
fungal laryngitis can be treated by use of oral antifungal. Treatment is usually required for three weeks period and may be repeated if needed.
Mucolytics like guaifenesin may be used for clearing secretions.
Certain authors also recommend the use of osmolyte ecotine containing oral and throat sprays.
In addition to lifestyle and dietary modification gastroesophageal reflux disease-related laryngitis is treated with antireflux medications. Antacid medications that suppress the acid production such as H2 receptor and proton pump blocking agents are highly effective against gastroesophageal reflux. Among all these groups, proton pump inhibitors are found to be most effective.
Prevailing data do not support the prescription of antihistaminics or oral corticosteroids for treating acute laryngitis.
This includes spasmodic dysphonia, reflux laryngitis, chronic allergic laryngitis, epiglottitis or coryza.
As this is a self-limiting condition, it carries a good prognosis. If patient sticks to above-mentioned therapy, the prognosis for recovery to a premorbid level of phonation is excellent.
Acute laryngitis is a self limiting condition. Voice rest is recommended. (Level 1) Antihistaminics and oral steroids have no role in treatment. (Level 1)