Laryngitis Non-technical

Laryngitis is one type of dysphonia (disorders of the voice) and is caused by inflammation of the larynx, resulting in distortion (hoarseness) of the voice. Sometimes irritation of the vocal cords, which are contained within the larynx, causes a complete, but temporary, loss of the voice.

Acute laryngitis usually lasts for less than a few days and usually causes only strain on the vocal cords, while the chronic form of the inflammation can extend out to several weeks and may cause serious problems.

Demographics

The disorder is found in both children and adults, and is equally common in all races of people all over the world. It is equally prevalent in men and women.

Description

When air is breathed in (inspired), it passes through the nose and the nasopharynx or through the mouth and the oropharynx. These are both connected to the larynx, a tube made of cartilage. The vocal cords, responsible for setting up the vibrations necessary for speech, are located within the larynx. They consist of two folds of mucous membrane,which surround muscle and cartilage. The air continues down the larynx to the trachea. The trachea then splits into two branches, the left and right bronchi (bronchial tubes). These bronchi branch into smaller air tubes which run within the lungs, leading to the small air sacs of the lungs (alveoli).

Either food, liquid, or air may be taken in through the mouth. While air goes into the larynx and the respiratory system, food and liquid are directed into the tube leading to the stomach, the esophagus. Because food or liquid in the bronchial tubes or lungs could cause a blockage or lead to an infection, the airway must be protected. The epiglottis is a leaf-like piece of cartilage extending upwards from the larynx. The epiglottis can close down over the larynx when someone is eating or drinking, preventing these substances from entering the airway.

In laryngitis, the tissues below the level of the epiglottis are swollen and inflamed. This causes swelling around the area of the vocal cords, so that they cannot vibrate normally. A hoarse sound to the voice is very characteristic of laryngitis. Laryngitis is a very common problem, and often occurs during the course of an upper respiratory tract infection.

Causes and symptoms

Acute laryngitis is caused almost 100% of the time by a virus.The same viruses that cause the majority of simple upper respiratory infections (colds, bronchitis, etc.), along with the mumps and measles, are responsible for laryngitis. These include human parainfluenza viruses (HPIVs), influenzavirus A, human respiratory syncytial virus (RSV), human rhinovirus, coronaviruses, and enteric cytopathic human orphan virus (ECHO virus). Extremely rarely, bacteria such as Group A streptococcus bacterium (Streptococcus pyogenes), Moraxella catarrhalis, or those strains of mycobacteria (usually Mycobacterium tuberculosis) that cause tuberculosis may cause laryngitis. In people with faulty immune systems (particular due to acquired immunodeficiency syndrome, or AIDS), infections with fungi may be responsible for laryngitis. In addition, factors that can contribute to laryngitis include allergies, acid reflux disease or similar problems, alcohol consumption, smoking tobacco products, and excessive coughing.

Chronic laryngitis is usually caused by strain to the vocal cords from inhaled irritants (chemical fumes, smoke, etc.), excessive alcohol use, chronic sinusitis, smoking, acid reflux, and excessive use of the voice (singers, etc.). It can also be caused, although less frequently, by bacterial, fungal, or parasitic infections. Chronic laryngitis can also be caused by cancer or tumors, vocal cord paralysis (from injuries, strokes or other health problems, and age-related problems).

Symptoms usually begin along with, or following, symptoms of a cold. A sore, scratchy, dry throat; fever; runny nose; achiness; and fatigue may all occur. Difficulty swallowing sometimes occurs with streptococcal infections. The patient may cough and wheeze. Most characteristically, the patient’s voice will sound weak, strained, hoarse, and raspy. Sometimes the voice is temporarily lost. Swollen lymph nodes in the throat, face, or chest may also be present.

In extremely rare cases, the swelling of the larynx may cause symptoms of airway obstruction. This is more common in infants, because the diameter of their airways is so small. In that case, the baby may have a greatly increased respiratory rate, and exhibit loud high pitched sounds with breathing (called stridor). In other cases, blood may be coughed up, increased production of saliva in the mouth may be present, and difficulties in eating may also occur.

Diagnosis

A visit to the doctor is necessary if such symptoms last for over a few days. If hoarseness remains for more than two weeks, then a trip to a physician is wise. For children, always seek medical care if the child has trouble swallowing, difficulty breathing, a body temperature of over 103F (39C), excessive drooling, and noisy, high-pitched sounds while inhaling. When at the health-care professional, the diagnosis is usually made by learning the history of a cold followed by hoarseness. The throat usually appears red and somewhat swollen. Listening to the chest and back with a stethoscope may reveal some harsh wheezing sounds with inspiration (breathing in).

In long-standing (chronic laryngitis), tuberculosis may be suspected. Using a scope called a laryngoscope, examination of the airway will show redness, swelling, small bumps of tissue called nodules, and irritated pits in the tissue called ulcerations. The medical professional will examine the back of the throat with a small, lighted mirror. In some cases, a fiber-optic laryngoscopy may be performed. In such procedures, an endoscope with a small camera and light is inserted into the nose ormouth so that the physician can examine the throat and, especially, watch the action of the vocal cords while the patient is speaking.

In other cases, the medical team may analyze a sample of tissue suspected as part of the laryngitis. The biopsy will be removed and taken to a medical laboratory where it will be examined under a microscope. In still other cases, special skin testing (TB testing) will reveal whether the individual has been exposed to the bacteria causing tuberculosis (TB).

Treatment

Treatment of a simple, viral laryngitis simply addresses the symptoms. Gargling with warm salt water, pain relievers such as acetaminophen, the use of vaporizers to createmoist air, and restwill help the illness resolve within a week. Corticosteroids may sometimes be used to reduce inflammation. However, such medication is usually only used in certain cases, such as when the laryngitis is more severe or there is an urgent need to recover more quickly.

Antibiotic or anti-fungal medication may be prescribed or given if the laryngitis is due to a bacterial or fungal infection, respectively.

In an infant who is clearly struggling for air, it may be necessary to put in an artificial airway for a short period of time. This is very rarely needed.

An individual with tubercular laryngitis is treated with a combination of medications used to treat classic TB. In people with fungal laryngitis, a variety of antifungal medications are available.

If laryngitis is caused by gastroesophageal reflux, sometimes also called gastroesophageal reflux disease (GERD), the person may be given ranitidine hydrochloride (Zantac) or omeprazole (Prilosec) for one to two months.

For laryngitis patients with severe hoarseness a visit to the voice pathologist or laryngologist may be necessary. In some cases speech therapy or a various surgical procedures may be recommended. People who sing or others who use their voices frequently (such as teachers) maybe asked to rest theirvoiceuntil it returns to normal.

Alternative treatment

Alternative treatments include aromatherapy inhalations made with benzoin, lavender, frankincense, thyme, and sandalwood. Decoctions (extracts made by boiling an herb in water) or infusions (extracts made by steeping an herb in boiling water) can be made with red sage (Salvia officinalis var. rubra) and yarrow (Achillea millefolium) or with licorice (Glycyrrhiza glabra). These are used for gargling, and are said to reduce pain. Echinacea (Echinacea spp.) tincture taken in water every hour for 48 hours is recommended to boost the immune system. Antiviral herbs, including usnea (Usnea spp.), lomatium (Lomatium dissectum), and ligusticum (Ligusticum porteri), may help hasten recovery from laryngitis. Homeopathic remedies are recommended based on the patient’s symptoms. Some people may get relief from placing cold compresses on the throat.

Prognosis

Prognosis for laryngitis is excellent. Recovery is complete, and usually occurs within a week’s time.

Prevention

Prevention of laryngitis is the same as for any upper respiratory infections. The only way to even attempt to prevent such illnesses is by good hand washing, and by avoiding situations where one might come in contact with people who might be sick. However, even with relatively good hygiene practices, most people will get about five to six colds per year. It is unpredictable which of these may lead to laryngitis. In addition, do not smoke and avoid situations where second-hand smoke may be present. Also, drink plenty of water daily to keep the throat moist.

Key terms

  • Epiglottis—A leaf-like piece of cartilage extending upwards from the larynx, which can close like a lid over the trachea to prevent the airway from receiving any food or liquid being swallowed.
  • Larynx—The part of the airway lying between the pharynx and the trachea.
  • Nasopharynx—The part of the airway into which the nose leads.
  • Oropharynx—The part of the airway into which the mouth leads.
  • Trachea—The part of the airway which leads into the bronchial tubes.