Laryngitis

Description

• Laryngitis is inflammation, erythema, and edema of the mucosa of the larynx and/or vocal cords characterized by hoarseness, loss of voice, throat pain, coughing, and often a negative impact on a person’s quality of life and daily activities.
• There is a range of severity, but most cases are acute and are associated with viral upper respiratory infection, irritation, or acute vocal strain.
• System(s) affected: pulmonary; ears, nose, throat (ENT)
• Synonym(s): acute laryngitis; chronic laryngitis; croup or laryngotracheitis (in children)

Epidemiology

Children are more susceptible than adults due to increased risk of symptomatic inflammation from smaller airway.

Prevalence
Common; approximately 1.7% of population have dysphonia with 50% of this being caused by acute laryngitis. Prevalence rates are increasing but difficult to calculate because many patients do not seek medical attention.

Etiology and Pathophysiology

• Misuse or abuse of voice
• Infectious
  • Viral: influenza A, B; parainfluenza; adenovirus; coronavirus; rhinovirus; human papillomavirus; cytomegalovirus; varicella-zoster virus; herpes simplex virus; respiratory syncytial virus; coxsackievirus, COVID-19 (SARS-CoV-2)
  • Fungal: uncommon but thought to be underdiagnosed, potentially accounting for up to 10% of presentations in both immunocompromised and immunocompetent patients; risk factors include recent antibiotic or inhaled corticosteroid use (1): histoplasmosis, blastomycosis, Coccidioides, Cryptococcus, and Candida.
  • Bacterial (uncommon): β-hemolytic streptococcus, Streptococcus pneumoniae, Haemophilus influenzae, tuberculosis (TB), leprosy, Moraxella catarrhalis, Mycoplasma pneumoniae, Chlamydophila pneumoniae; in patients with chronic laryngitis, methicillin-resistant Staphylococcus aureus (MRSA) should be considered as a potential cause.
  • Secondary syphilis if left untreated
  • Leprosy (in 30–55% of those with leprosy, larynx is affected; in tropical and warm countries)
• Irritants
  • Inhalation of irritating substances (e.g., air pollution, cigarette smoke)
  • Aspiration of caustic chemicals
  • Gastroesophageal reflux disease (GERD)/laryngopharyngeal reflux disease (LPRD)
  • Excessively dry environment
  • Allergy exposures (including pollens)
• Anatomic
  • Aging changes: muscle atrophy, loss of moisture in larynx, and bowing of vocal cords
  • Vocal cord nodules/polyps (“singer’s nodes”)
  • Local cancer
• Iatrogenic: inhaled steroids such as those used to treat asthma, surgical injury, endotracheal intubation injury
• Neuromuscular disorder (e.g., myasthenia gravis); stroke
• Rheumatoid arthritis
• Trauma (e.g., blunt or penetrating trauma to neck)

Risk Factors

• Acute:
  • Infection or trauma
  • Upper respiratory tract viral infection (e.g., influenza, rhinovirus, adenovirus, parainfluenza)
  • Voice overuse—excessive talking, singing, or shouting
  • Pneumonia—viral or bacterial
  • Coughing
  • Lack of immunization against pertussis or diphtheria
  • Immunocompromised
  • Recent endotracheal intubation or local surgery
• Chronic (persists beyond 3 weeks):
  • Allergic laryngitis
  • Chronic rhinitis/sinusitis with postnasal drip (PND)
  • Voice abuse
  • GERD/LPRD (1)
  • Smoking: primary or secondhand
  • Excessive alcohol use
  • Autoimmune disorders (e.g., rheumatoid arthritis)
  • Granulomatous diseases (e.g., sarcoidosis)
  • Stroke
  • Environmental pollution; constant exposure to dust or other irritants such as chemicals at workplace
  • Medications: inhaled steroids, anticholinergics, antihistamines, anabolic steroids

Geriatric Considerations
May be more ill, slower to heal; need to consider neoplasm

Pediatric Considerations

• Common
• Consider congenital/anatomic causes.

General Prevention

• Avoid overuse of voice (speech therapy/voice training is helpful for vocal musicians/public speakers).
• Influenza virus vaccine is recommended, as well as other routine vaccines.
• Quit smoking and avoid secondhand smoke.
• Limit or avoid alcohol/caffeine/acidic foods.
• Control GERD/LPRD.
• Maintain proper hydration status.
• Avoid allergens.
• Wear mask around chemical/environmental irritants.
• Good hand washing (infection prevention)

Commonly Associated Conditions

• Viral pharyngitis
• Diphtheria (rare): Membrane can descend into the larynx.
• Pertussis: larynx involved as part of the respiratory system
• Bronchitis; pneumonitis
• Croup, epiglottitis, in children