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Laryngitis

Laryngitis is a topic covered in the 5-Minute Clinical Consult.

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Basics

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

  • Predominant age: affects all ages
  • Children more susceptible than adults due to increased risk of symptomatic inflammation from smaller airways
  • Predominant sex: male = female

Incidence
Common

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
    • 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
    • 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
  • Idiopathic
  • 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—excess talking, singing, or shouting
    • Pneumonia—viral or bacterial
    • Coughing
    • Lack of immunization for pertussis or diphtheria
    • Immunocompromised
    • Recent endotracheal intubation or local surgery
  • Chronic (persists beyond 3 weeks):
    • Allergic laryngitis (2)
    • Chronic rhinitis/sinusitis
    • Voice abuse
    • GERD/LPRD (1)
    • Smoking: primary or secondhand
    • Excessive alcohol use
    • Autoimmune disorders (e.g., rheumatoid arthritis) (1,3)
    • Granulomatous diseases (e.g., sarcoidosis) (1)
    • 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 in this age group
  • 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.
  • 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

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Citation

Stephens, Mark B., et al., editors. "Laryngitis." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116339/0.3/Laryngitis.
Laryngitis. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116339/0.3/Laryngitis. Accessed July 21, 2019.
Laryngitis. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116339/0.3/Laryngitis
Laryngitis [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 July 21]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116339/0.3/Laryngitis.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Laryngitis ID - 116339 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116339/0.3/Laryngitis PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -