Sore throat

Updated 15 August 2016

Laryngitis

Laryngitis is inflammation of the larynx (voice box).

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What is laryngitis?

Laryngitis is a common condition involving inflammation of the larynx (voice-box) and surrounding tissues. The vocal cords become inflamed or irritated and swell, causing temporary hoarseness. This inflammation may be of primary origin or secondary to other disorders.

Acute laryngitis is caused by a viral or bacterial infection of the larynx, and can follow a number of illnesses, such as tonsillitis, bronchitis, pneumonia and flu.

Chronic laryngitis has some of the same symptoms as acute laryngitis, but it is caused by irritation or overuse of the voice.

The larynx and laryngitis

Hoarse voice is caused by a disruption in the normal operation of the larynx, or voice box. The larynx is located in the throat at the top of the airway to the lungs (windpipe) and contains the vocal cords. These are two folds of mucous membrane covering muscle and cartilage. Normally, as air passes over them, the vocal cords open and close smoothly, forming sounds through the movement and vibration of mucosal folds on their surface.  The tongue, lips, and teeth turn these sounds into speech. However, when they become inflamed or infected, the vocal cords swell, causing the voice to become hoarse, muted, or silent. Occasionally, obstruction of the airway may also result from swelling.

What are the causes?

The following are common causes of laryngitis:

  • Illness – viral or bacterial upper respiratory tract infections can spread to the vocal cords. This is the most common cause of laryngitis. Illnesses with which laryngitis may be associated include the common cold, bronchitis, flu, pneumonia, tuberculosis and sinusitis. Viruses that tend to cause croup in children may cause laryngitis in adults.
  • Excessive use of the voice – excessive use of the voice is common in certain jobs, such as teaching or public speaking. It can also result from cheering at sports events. Singing, screaming or shouting too loudly over a period of time may result in oedema (swelling) of the vocal cords, and laryngitis. Regular overuse can cause sores (contact ulcers) or the growth of nodules on your vocal cords, which can cause hoarseness.
  • Polyps – continued overuse or abuse of your vocal cords may cause polyps along your vocal cords. Polyps are small growths or outpouchings of inflamed mucous membranes, which can interfere with normal vocal cord movement, causing hoarseness.
  • Smoking – smoking can cause chronic inflammation of your vocal cords. It can also lead to cancerous growths on your cords that can cause hoarseness.
  • Heartburn (oesophageal reflux) – frequent regurgitation of stomach juices into your oesophagus and throat can cause laryngeal inflammation and contact ulcers on your vocal cords.
  • Ageing – as you age, your vocal cords can lose tension.
  • Vocal paralysis – injury to or pressure on the nerves supplying muscles that move your vocal cords can cause vocal cord, or laryngeal, paralysis.
  • Allergies – these can cause inflammation of the vocal cords and surrounding area.
  • Electrolyte-balance disturbances – occasionally this can cause muscle weakness, especially if potassium is low.
  • Endocrine - especially an underactive thyroid can cause hoarseness.
  • Constant exposure to dust or other airborne irritants
  • Breathing mostly through the mouth
  • Alcohol abuse
  • Premalignant changes of the vocal mucosa
  • Tumours (rare)

What are the symptoms of laryngitis?

Symptoms may include:
  • Hoarseness or loss of voice, ranging from mild to complete loss of voice
  • Coughing
  • Sore throat, tickling in the back of the throat
  • Some pain in the larynx when speaking or swallowing
  • The urge to clear your throat
  • Sensation of a lump in the throat
  • Slight fever (sometimes)
  • Swallowing difficulty (rare)
  • Tiredness
  • Common laryngitis is not normally associated with any breathing difficulty (respiratory distress). However, in infants and younger children, laryngitis can sometimes further narrow an already smaller airway and lead to breathing problems. Parents should watch for signs of narrowed airways, including a grunting or wheezing sound each time the child breathes; chest muscles that retract (suck inwards) as the child struggles to inhale; either unusual restlessness or unusual sleepiness; pale skin; or a blue or grey colour to lips or fingernails.

Prevalence

  • Almost everyone has experienced laryngitis.
  • Laryngitis affects both sexes and all ages, and is probably the most common disorder affecting the larynx and voice.
  • It is more common during epidemics of seasonal virus infections (late autumn, winter, early spring).
  • Several forms of laryngitis are peculiar to children and can lead to significant or fatal respiratory obstruction.

Course

Spontaneous recovery for viral laryngitis occurs in 10 to 14 days. Bacterial infections are usually curable in seven to 10 days with antibiotic treatment.

Risk factors

  • Exposure to irritants distributed by air-conditioning systems, such as mould, pollen and pollutants
  • Extremely cold weather
  • Smoking
  • Excessive alcohol consumption
  • Recent respiratory illness, such as bronchitis or pneumonia

When to see a doctor

In most cases, hoarse voice can be attributed to a minor respiratory tract illness or irritation from vocal misuse. These tend to go away after a few days. However, laryngitis can also be secondary to a more serious condition such as benign or malignant growths.

If you exhibit the following symptoms, you should consult a physician immediately:

  • Signs of a bacterial infection
  • Hoarseness or other symptoms of laryngitis that last longer than two weeks – though rare, it could be an early sign of cancer, especially if the hoarseness does not seem to have any identifiable cause.
  • Hoarseness accompanied by a lump in the neck or coughing with blood-tinged sputum.
  • Feeling very ill, with a high fever or difficulty breathing – if these symptoms develop in a child, call your doctor immediately.
  • Laryngitis symptoms in a child, combined with difficulty breathing; fever; chills; nausea or vomiting; trouble swallowing foods, liquids, or their own saliva (an older child starts drooling uncontrollably); or a hoarse voice that lasts more than one week
  • Hoarseness in a child less than three months old
  • Difficulty swallowing
  • A deep cough or, in a young child, a barking cough like that of a seal
  • Brown, green or yellow sputum
  • Being too ill to carry on normal activities
  • Gasping or drooling
  • Laryngitis outlasting other symptoms
  • Laryngitis developing after inhalation of poisonous fumes
  • Persistent hoarseness in a smoker

Diagnosis

Diagnosis of laryngitis is typically based on:
  • Your own observation of symptoms
  • Medical history and physical exam by a doctor – the opinion of an ear, nose and throat specialist might be helpful for persistent cases.

Treatment

General

Since most common laryngitis is viral, treatment with antibiotics is generally not indicated. However, when caused by a bacterial infection, treatment for acute laryngitis may include an antibiotic and complete voice rest. Chronic laryngitis is usually treated by complete voice rest, steam inhalations and avoiding irritants such as cigarette smoke and alcohol. Treatment won't work unless the underlying cause is removed.

Home

Laryngitis usually heals in five to ten days, and medication does little to speed recovery. The following methods of home treatment may prove effective:
  • If hoarseness is caused by a cold, treat the cold. Hoarseness may persist up to a week after a cold.
  • For a hoarse voice caused by overuse or respiratory infection, resting your voice for a few days is the main treatment, and may be all that you need. This is also the primary treatment for contact ulcers caused by overuse. Voice rest reduces inflammation of the vocal cords and helps the voice.
  • Don't use your voice unless absolutely necessary, and then speak softly (even whispering may strain vocal cords). Try using a notepad and pencil to write notes instead. Avoid clearing your throat.
  • Don't smoke, and avoid secondary cigarette smoke. Stay away from places with smoky air and other air-borne irritants.
  • Humidify the air in your home with a humidifier, especially in your bedroom. Moistening the air will help to ease the constricted or scratchy feeling in your throat. Clean the humidifier daily. Hot, steamy showers or steam baths also help.
  • Avoid air conditioning.
  • To soothe the throat, gargle several times a day with warm salt water (a quarter teaspoon of salt in half a cup of water). Wait two to three days before using this method, because at first it may add to throat irritation.
  • If you suspect stomach acid problems may be contributing to your laryngitis, treating your heartburn may help. Gastroesophageal reflux is initially treated symptomatically.
  • Don't use mouthwashes, as many contain alcohol, which is irritating.
  • Increase intake of fluids, particularly water. Drink plenty of non-alcoholic or decaffeinated fluids, and warm drinks, such as honey in hot water, lemon juice, or weak tea.
  • Rest more frequently.
  • Coughing makes hoarseness much worse. Use cough syrup or drops to repress a dry cough. However, it is important to remember that when you have a cold, coughing has the important purpose of clearing mucus and germs from the throat and lungs.
  • Sucking on cough drops, medicated throat lozenges or hard sweets can also soothe your throat. (Do not give these to children under age five.)
  • For minor discomfort, you may use non-prescription drugs, such as aspirin or acetaminophen.
  • If your child has symptoms of laryngitis without signs of serious infection, you can usually treat him or her at home. Give your child a non-aspirin pain medicine, like acetaminophen, to ease throat discomfort. Remind her to rest her voice – perhaps by speaking in a whisper yourself. Give older children a note pad for writing requests. Offer your child plenty of liquids – warm or cool. Ice cream, lollies and jelly, or warm soup or tea may be soothing. Use a cool-mist vaporiser to humidify the air and soothe your child's irritated breathing passages. Ask all smokers to avoid smoking at home, especially near the child.

Medication

The initial treatment of laryngitis addresses the causative factors. For minor discomfort, you may use non-prescription drugs, such as acetaminophen, aspirin or cough syrup. Antibiotics may be prescribed for bacterial infections. Decongestants and analgesics may provide some symptomatic relief from the accompanying upper respiratory infection. Medications that control acid reflux may be used if this is a suspected cause. In severe cases, systemic steroids may be prescribed to reduce inflammation and oedema.

Surgery

If polyps are the cause of your hoarse voice, having them removed may solve the problem, but only if vocal therapy by a speech therapist has been unsuccessful. Physicians recommend voice therapy in any case to help prevent return of polyps.

There are also a number of surgical procedures which have been developed to deal with certain specific vocal cord disorders causing hoarseness, which makes seeking out expert medical opinion a very worthwhile exercise for voice problems.

Prevention

  • Try to avoid upper respiratory tract infections during cold and flu season.
  • Practice good personal hygiene such as hand washing, and avoid crowded environments and people with infectious respiratory illnesses.
  • To prevent hoarseness, stop shouting or straining your voice as soon as you feel minor pain. Give your vocal cords a rest.
  • Treat respiratory infections carefully.

Reviewed by Dr D. Wagenfeld, M.B.Ch.B, M.Med, F.C.S.

 

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