Laryngitis overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Anthony Gallo, B.S. [2]
Overview
Laryngitis is an inflammation of the larynx. It causes a hoarse voice or the complete loss of the voice because of irritation to the vocal folds (vocal cords). Laryngitis is categorized as acute if it lasts less than a few days.[1] Otherwise, it is categorized as chronic and may last over 3 weeks.
Historical Perspective
Laryngitis is an ancient disease. In 1840, Dr. Jordan Roche Lynch, an English physician, published a case study on the treatment of acute laryngitis.[2] In 2005, Drs. Reveiz, Cardona, and Ospina demonstrated that antibiotics were not effective in the treatment of laryngitis.[3]
Classification
Based on the duration of symptoms, laryngitis may be classified into either acute or chronic.[4] Generally, acute laryngitis has an abrupt onset and is self-limiting; typically, it clears within 3-5 days.[5] Chronic laryngitis may be defined as lasting greater than 3 weeks.[6]
Pathophysiology
The voice box (larynx) is located at the top of the airway to the lungs (trachea). The larynx contains the vocal cords. When the vocal cords become inflamed or infected, they swell. This can cause hoarseness, and may sometimes block the airway.
Causes
Laryngitis may be the result of infectious or noninfectious causes. The most common causes of laryngitis are due to viral infections, and include rhinovirus, adenovirus, influenza virus, parainfluenza virus, and respiratory syncytial virus. Common bacterial causes of laryngitis include Staphylococcus aureus and Haemophilus influenzae.
Differentiating Laryngitis from Other Diseases
Laryngitis must be differentiated from upper respiratory tract infection, vocal fold cyst, nodule, or polyp, and laryngeal stenosis.
Epidemiology and Demographics
Acute laryngitis commonly affects children. Women are more commonly affected with laryngitis than men.[7] The incidence of laryngitis in the winter is double that of the summer.[8]
Risk Factors
Common risk factors in the development of laryngitis include upper respiratory infection, asthma, and cigarette smoke.
Screening
Screening for laryngitis is not recommended.
Natural History, Complications, and Prognosis
If left untreated, generally acute laryngitis will naturally resolve between 3-7 days.[9] Common complications of laryngitis include mild throat pain. Prognosis for laryngitis is generally excellent; there is no known mortality rate.
Diagnosis
History and Symptoms
Symptoms of laryngitis include hoarseness, cough, and swollen lymph nodes.[10][11]
Physical Examination
Patients with laryngitis usually appear well. Physical examination of patients with laryngitis is usually remarkable for vocal fold cyst, vocal fold nodules, and swollen lymph nodes in the neck.[12][13]
Laboratory Findings
There are no diagnostic lab findings associated with laryngitis.
Imaging Findings
Electrocardiogram
There are no electrocardiogram findings associated with laryngitis.
X Ray
There are no x ray findings directly associated with laryngitis. On x ray of the neck, supraglottic or retropharyngeal swelling, unusual narrowing, or soft tissue density in subglottic airway may be observed.[14]
CT
There are no CT findings directly associated with laryngitis. CT may be ordered when pathology outside of the larynx is suspected.[15]
MRI
There are no MRI findings directly associated with laryngitis. MRI may be ordered when pathology outside of the larynx is suspected.[16]
Laryngoscopy
Laryngoscopy is indicated when hoarseness lasts longer than two weeks and does not have an apparent benign cause; this can occur via direct or indirect laryngoscopy.[12][17][18]
Treatment
Medical Therapy
There is no treatment for viral laryngitis; the mainstay of therapy is supportive care. The mainstay of therapy for infectious causes of laryngitis is antimicrobial therapy. Medical therapy for laryngitis due to gastroesophageal reflux includes acid suppression therapy such as either omeprazole or ranitidine.
Surgery
Surgery is not the first-line treatment option for patients with laryngitis. Surgery is usually reserved for patients with persistent laryngitis due to vocal cord nodules.[19][20]
Primary Prevention
Effective measures for the primary prevention of laryngitis include avoidance of people with upper respiratory infections, hand washing, and smoking cessation.[21][22]
Secondary Prevention
Effective measures for the secondary prevention of laryngitis include avoidance of throat clearing, increased fluid intake, and limit vocal cord usage.[8][22]
References
- ↑ University of Michigan Health System. 2005. Laryngitis. McKesson Provider Technologies. Retrieved on May 16, 2007.
- ↑ Lynch JR (1841). "Case of acute laryngitis in which tracheotomy was performed". Prov Med Surg J (1840). 3 (60): 148–9. PMC 2489466. PMID 21379785.
- ↑ Reveiz L, Cardona AF, Ospina EG (2005). "Antibiotics for acute laryngitis in adults". Cochrane Database Syst Rev (1): CD004783. doi:10.1002/14651858.CD004783.pub2. PMID 15674965.
- ↑ Frazier MS, Drzymkowski J. Essentials of Human Diseases and Conditions - Text and Elsevier Adaptive Learning Package. Saunders; 2015.
- ↑ Weidner TG (1994). "Reporting behaviors and activity levels of intercollegiate athletes with an URI". Med Sci Sports Exerc. 26 (1): 22–6. PMID 8133733.
- ↑ Laryngitis. The Mayo Clinic http://www.mayoclinic.org/diseases-conditions/laryngitis/basics/causes/con-20021565 Accessed on September 28, 2016.
- ↑ Roy N, Kim J, Courey M, Cohen SM (2016). "Voice disorders in the elderly: A national database study". Laryngoscope. 126 (2): 421–8. doi:10.1002/lary.25511. PMID 26280350.
- ↑ 8.0 8.1 Dworkin JP (2008). "Laryngitis: types, causes, and treatments". Otolaryngol Clin North Am. 41 (2): 419–36, ix. doi:10.1016/j.otc.2007.11.011. PMID 18328379.
- ↑ Aydin O, Ozturk M, Anik Y (2007). "Superior laryngeal neuralgia after acute laryngitis and treatment with a single injection of a local anesthetic". Arch Otolaryngol Head Neck Surg. 133 (9): 934–5. doi:10.1001/archotol.133.9.934. PMID 17875862.
- ↑ Wood JM, Athanasiadis T, Allen J (2014). "Laryngitis". BMJ. 349: g5827. doi:10.1136/bmj.g5827. PMID 25300640.
- ↑ Gavrila GA, Mihaila RG, Manitiu I (2015). "Differential diagnosis problems in a patient with dysphonia and chronic lymphocytic leukemia". Pak J Med Sci. 31 (1): 223–5. doi:10.12669/pjms.311.6091. PMC 4386192. PMID 25878649.
- ↑ 12.0 12.1 Feierabend RH, Shahram MN (2009). "Hoarseness in adults". Am Fam Physician. 80 (4): 363–70. PMID 19678604.
- ↑ Schwartz SR, Cohen SM, Dailey SH, Rosenfeld RM, Deutsch ES, Gillespie MB; et al. (2009). "Clinical practice guideline: hoarseness (dysphonia)". Otolaryngol Head Neck Surg. 141 (3 Suppl 2): S1–S31. doi:10.1016/j.otohns.2009.06.744. PMID 19729111.
- ↑ Laryngitis. National Health Service - United Kingdom. http://www.nhs.uk/Conditions/Laryngitis/Pages/Diagnosis.aspx Accessed on 2 November 2016
- ↑ Smith MM, Mukherji SK, Thompson JE, Castillo M (1996). "CT in adult supraglottitis". AJNR Am J Neuroradiol. 17 (7): 1355–8. PMID 8871724.
- ↑ Baert AL. Encyclopedia of Imaging. Springer Science & Business Media; 2008. https://books.google.com/books?id=e3F4NaY3fgQC&pg=PA1044&lpg=PA1044&dq=when+to+order+mri+on+laryngitis&source=bl&ots=mHB8ogQeRT&sig=NSaiin0RdrttXDaq2QcnLLlxvMs&hl=en&sa=X&ved=0ahUKEwjwqc6-z4rQAhUG7CYKHcNMCpgQ6AEIOjAF#v=onepage&q=when%20to%20order%20mri%20on%20laryngitis&f=false Accessed on November 2, 2016
- ↑ Garrett CG, Ossoff RH (1999). "Hoarseness". Med Clin North Am. 83 (1): 115–23, ix. PMID 9927964.
- ↑ Rosen CA, Anderson D, Murry T (1998). "Evaluating hoarseness: keeping your patient's voice healthy". Am Fam Physician. 57 (11): 2775–82. PMID 9636340.
- ↑ Reveiz L, Cardona AF, Ospina EG (2007). "Antibiotics for acute laryngitis in adults". Cochrane Database Syst Rev (2): CD004783. doi:10.1002/14651858.CD004783.pub3. PMID 17443555.
- ↑ Reveiz L, Cardona AF (2015). "Antibiotics for acute laryngitis in adults". Cochrane Database Syst Rev (5): CD004783. doi:10.1002/14651858.CD004783.pub5. PMID 26002823.
- ↑ Hanson DG, Jiang JJ (2000). "Diagnosis and management of chronic laryngitis associated with reflux". Am J Med. 108 Suppl 4a: 112S–119S. PMID 10718463.
- ↑ 22.0 22.1 Danielides V, Nousia CS, Patrikakos G, Bartzokas A, Lolis CJ, Milionis HJ; et al. (2002). "Effect of meteorological parameters on acute laryngitis in adults". Acta Otolaryngol. 122 (6): 655–60. PMID 12403130.