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Acute laryngitis

Article · December 2018

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NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2018 Jan-.

Acute Laryngitis
Authors

Gunjan Gupta1; Kunal Mahajan2.

Affilations
1 IGMC
2 Holy Heart Advanced Cardiac Care and Research Centre

Last Update: November 22, 2018.

Introduction
Laryngitis refers to inflammation of the larynx and can present in both acute and chronic form.[1]
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.

Etiology
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.

Epidemiology
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.

Pathophysiology
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. 

History and Physical

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:

Change in quality of voice, in later stages there may be a complete loss of voice (aphonia).

Discomfort and pain in the throat, particularly after talking.

Dysphagia, odynophagia

Dry irritating cough which worsens at night.

General symptoms of dryness of throat, malaise, and fever.

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.

Evaluation
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 / Management
Treatment is often supportive in nature and depends on the severity of laryngitis.

Voice rest: This is the single most important factor. Use of voice during laryngitis results in
incomplete or delayed recovery. Complete voice rest is recommended although it is impossible
to achieve. If the patient needs to speak, soft sighing speech is best.

Steam Inhalation: Inhaling humidified air enhances moisture of upper airway and helps in
removal of secretions and exudates.

Avoidance of irritants: Smoking and alcohol should be avoided. Smoking delays prompt
resolution of the disease process

Dietary modification: dietary restriction is recommended for patients with gastroesophageal

reflux disease. This includes avoiding caffeinated drinks, spicy food items, fatty food,
 chocolate, peppermint. Another important lifestyle modification is avoidance of late meals.
The patient should have meals at least 3 hours before sleeping. The patient should drink
plenty of water.

Medications: Antibiotics prescription for an otherwise healthy patient with acute laryngitis is
currently unsupported; however for high-risk patients and patients with severe symptoms
antibiotics may be given. Some authors recommend narrow-spectrum antibiotics only in
presence of identifiable gram stain and culture.

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.

Differential Diagnosis
This includes spasmodic dysphonia, reflux laryngitis, chronic allergic laryngitis, epiglottitis or
coryza.

Prognosis
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.

Enhancing Healthcare Team Outcomes

Acute laryngitis is a self limiting condition. Voice rest is recommended. (Level 1) Antihistaminics
and oral steroids have no role in treatment. (Level 1)

Questions
To access free multiple choice questions on this topic, click here.

References
1. Jaworek AJ, Earasi K, Lyons KM, Daggumati S, Hu A, Sataloff RT. Acute infectious laryngitis: A
case series. Ear Nose Throat J. 2018 Sep;97(9):306-313. [PubMed: 30273430]

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