- 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)
Children are more susceptible than adults due to increased risk of symptomatic inflammation from smaller airway.
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
- 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 (2).
- Secondary syphilis if left untreated
- Leprosy (in 30–55% of those with leprosy, larynx is affected; in tropical and warm countries)
- 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)
- 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)
- 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
- Lack of immunization against pertussis or diphtheria
- 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)
- Environmental pollution; constant exposure to dust or other irritants such as chemicals at workplace
- Medications: inhaled steroids, anticholinergics, antihistamines, anabolic steroids
May be more ill, slower to heal; need to consider neoplasm
- Consider congenital/anatomic causes.
- 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
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