Laryngitis

Definition and Clinical FeaturesTop

Laryngitis refers to acute (lasting <3 weeks) or chronic (>3 weeks) inflammation of the vocal folds and surrounding tissues.

Causes:

1) Acute laryngitis: Infection (most frequently with respiratory viruses), vocal overuse, irritants (tobacco smoke).

2) Chronic: As a consequence of acute laryngitis, gastroesophageal reflux, fungal infection in patients treated with inhaled corticosteroids, benign lesions of laryngeal structures (nodules, papillomas, cysts, polyps, chondromas), and other rare causes (granulomatosis with polyangiitis, malignancy, tuberculosis, endemic mycoses).

Risk factors: Tobacco smoking, irritants, iatrogenic (eg, inhaled drugs or treatments causing dryness of the laryngeal mucosa, intubation), nasal congestion, alcohol use.

Signs and symptoms: Discomfort when speaking or swallowing, cough, hoarseness, sometimes stridor. The presence of concomitant fever is suggestive of intercurrent infection. In patients with fever, a toxic appearance, significant stridor, or dyspnea, always exclude bacterial tracheitis and epiglottitis.

DiagnosisTop

The diagnosis of acute laryngitis is based on clinical features. Symptoms lasting >3 weeks are an indication for an ear, nose, and throat (ENT) consultation. In the diagnostic workup of chronic laryngitis laryngoscopy is necessary to exclude malignancy.

TreatmentTop

Treatment is symptomatic and includes voice rest, air humidification, cessation of smoking, elimination of irritants, and oral nonsteroidal anti-inflammatory drugs. In the case of significant edema of vocal cords or urgent need for at least transient improvement of symptoms, you may consider a short course of oral glucocorticoids while seeking expert advice (in addition to adverse effects, glucocorticoids may mask the underlying process). Treatment of the underlying condition depends on etiology. Because the vast majority of acute laryngitis is caused by respiratory viruses, no specific treatment is indicated.