LARYNGITIS

Laryngitis refers to inflammation of the larynx. This is often due to an acute viral infection,
which is typically a mild and self-limiting condition that lasts for a period of 3 to 7 days.

Causes

Viral agents such as rhinovirus, parainfluenza virus, respiratory syncytial virus, coronavirus,
adenovirus, and influenza

Bacterial organisms are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella

catarrhalis

Non-infectious laryngitis can be due to vocal trauma/abuse/misuse, allergy, gastroesophageal

reflux disease, asthma, environmental pollution, smoking, inhalational injuries, or
functional/conversion disorders

Pathophysiology

Acute laryngitis is characterized by inflammation and congestion of the larynx in the early
stages.. As the healing stage begins, white blood cells arrive at the site of infection to remove the
pathogens. This process enhances vocal cord edema and affects vibration adversely, changing the
amplitude, magnitude, and frequency of the normal vocal fold dynamic. As the edema
progresses, the phonation threshold pressure can increase. The generation of adequate phonation
pressure becomes more difficult, and the patient develops phonatory changes both as a result of
the changing fluid-wave dynamics of the inflamed and edematous tissue, but also as a result of
both conscious and unconscious adaptation to attempt to mitigate these altered tissue dynamics.
Sometimes edema is so marked that it becomes impossible to generate adequate phonation
pressure. In such a situation, the patient may develop frank aphonia.

Diagnosis

 Visual examination with flexible laryngoscope

 Laryngeal swab

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 almost
impossible to achieve.

Steam Inhalation: Inhaling humidified air enhances moisture of the upper airway and helps in
the 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 the avoidance of late meals. The patient
should have meals at least 3 hours before sleeping. The patient should drink plenty of water.

Medications:

 Antibiotics like erythromycin 500 mg PO q12hr

 Fungal laryngitis can be treated with the use of oral antifungal agents such as fluconazole.
 Proton pump inhibitors e.g Omeprazole can be given for cases of GERD induced laryngitis,
This blocks the final step in gastric acid production
 Mucolytics like guaifenesin may be used for clearing secretions.