Laryngitis

Written by Dr Mary-Louise Montague, specialist registrar in otolaryngology, Ninewells Hospital, Dundee

What is laryngitis?

The larynx is the organ of voice. When we speak, two membranes in the larynx - the vocal cords - vibrate to make sound. Laryngitis refers to inflammation or irritation of the tissues of the larynx. It is the bane of performers and other professionals who depend on their voice for their art and livelihood.

What causes laryngitis?

Almost every person has experienced acute (sudden onset) laryngitis, usually associated with a viral infection of the upper airways. But the inflammation can be caused by any kind of injury including:

infection

vocal overuse

smoking and other inhaled irritants

drinking of spirits

contact with caustic or acidic substances (including acid reflux from the stomach)

allergic reaction

direct trauma.

Why do the symptoms sometimes persist?

A more perplexing problem for professional voice users is laryngitis that is not associated with any signs of infection but which recurs or persists. This form of laryngitis, which lasts weeks or months, is termed chronic laryngitis.

Acute laryngitis may become chronic if the appropriate preventive measures are not adhered to rigidly.

What are the symptoms of laryngitis?

In acute laryngitis from a viral upper-respiratory infection, the voice becomes hoarse or is reduced to a whisper.

The most common symptom of early mild 'irritative' laryngitis is a feeling of postnasal drip with chronic throat clearing due to a sensation of secretions in the throat.

In chronic irritative laryngitis loss of voice quality with voice use, a feeling of irritation or of a lump in the throat, dryness or soreness (often worst in the morning upon wakening) may be features in addition to hoarseness (which often comes and goes).

Pain with laryngeal movements such as speaking or swallowing, is typical of more severe laryngitis. Chronic cough and wheeze brought on by exercise are signs of more advanced inflammation.

How is laryngitis diagnosed?

The diagnosis can be confirmed by inspection of the larynx by an ENT (ear, nose and throat) specialist. The earliest sign may be slight redness and dryness of the laryngeal lining with stringy mucus between the vocal cords. In chronic laryngitis the vocal cords often appear thickened.

How is laryngitis prevented or treated?

In acute laryngitis due to a cold the viral infection is almost always quickly conquered by the body's immune system and lasts at most a few days. It is still best to rest the voice while the larynx is inflamed. This along with steam inhalations and avoidance of smoke and other irritants is usually sufficient. Antibiotics are rarely necessary.

Lifestyle changes are often the most important factor in the prevention of chronic laryngitis.

These should include:

cessation of smoking and avoidance of smoky environments

avoidance of food and liquids for two to three hours before retiring in order to prevent having active acid secretion by the stomach during sleep.

raising the head of the bed, which protects the larynx from acid reflux from the stomach during sleep.

medication to reduce acid production by the stomach if symptoms persist despite these measures.

avoidance of throat clearing as this can worsen symptoms. It should be substituted by swallowing to clear bothersome throat secretions.

Voice therapy may be helpful in cases of faulty voice production.

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