What is Acute Laryngitis (Laryngitis)?
Laryngitis is a condition that causes inflammation of the larynx, also known as the voice box. There are two types: acute, which lasts between 3 to 7 days and is usually mild, and chronic, which lasts over 3 weeks.
Most of the time, a viral upper respiratory infection, like a cold or flu, causes acute laryngitis. Doctors can usually determine this by asking patients about their recent health and if they have been around anyone who is sick. However, if a patient hasn’t been ill or around sick people, the doctor may explore other non-infectious causes of laryngitis.
Some common signs of laryngitis include changes in voice, such as a raspy or hoarse sound, getting tired from using your voice, especially for those who sing or speak a lot in their jobs, or a dry cough. It’s not common for people with acute laryngitis to have difficulty breathing, but in rare cases, it may happen. If someone experiences significant breathlessness, shortness of breath, or can hear a whistling sound when they breathe, it might point to a more severe illness.
People who smoke and those with weakened immune systems should be more alert to these symptoms as they have a higher risk of serious infections and diseases that can mimic laryngitis. Similarly, if someone with laryngitis also experiences significant difficulty or pain when swallowing, drools excessively, or starts to posture differently, that’s not usually a sign of simple acute laryngitis and could hint to a more serious issue, requiring additional medical tests.
What Causes Acute Laryngitis (Laryngitis)?
Acute laryngitis, an inflammation of the voice box, can be traced back to either infectious or non-infectious causes. The infectious type usually comes after an upper respiratory tract infection, and is often caused by viruses such as the common cold virus, flu virus, or an array of others. While initially caused by a virus, a bacterial infection can also develop afterwards, typically a week into the viral infection.
The most frequent bacteria responsible are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Diseases like measles, chickenpox, and whooping cough can also trigger acute laryngitis, hence, it’s wise to know one’s vaccination history. Laryngitis due to fungal infection is quite rare unless the individual has a weakened immune system or is using inhaled steroid medications.
Adults and children usually get acute infectious laryngitis from the same viruses, although in kids, it could develop into a condition called croup, related to parainfluenza virus, distinguished by a “barking” cough, and could lead to difficulty in breathing.
On the other hand, non-infectious laryngitis could be a result of stress on the vocal cords from misuse, overuse, or allergies. It could also be caused by acid reflux disease, asthma, environmental pollution, smoking or inhalation injuries. In particular, shouting or yelling for prolonged periods can induce this condition, as seen in coaches, fans, athletes after an event, or singers without proper training.
Voice problems and laryngitis could also be a result of gastroesophageal reflux (GERD), commonly referred to as acid reflux, especially when it reaches the larynx, termed laryngopharyngeal reflux (LPR). Asthma may also lead to laryngitis because of irritation from inhaler usage. Chronic steroid inhaler usage can lead to fungal laryngitis, especially if the person is not rinsing their mouth with plain water after each use, as recommended. Environmental factors, like allergies or polluted air, may also contribute to acute laryngitis. Use or exposure to harmful substances can also irritate the larynx and cause swelling and voice changes. Some people may also have reactions to fragrances, detergents, or other products with strong scents.
Functional dysphonia, a condition which leads to various voice symptoms, is a diagnosis given after ruling out other possibilities. It’s known to be triggered by significant life stressors, like losing a job or a loved one.
Risk Factors and Frequency for Acute Laryngitis (Laryngitis)
Acute laryngitis is a condition that can happen to anyone, but it’s most commonly seen in adults between the ages of 18 and 40. However, even children as young as 3 can be affected. If kids under age 3 have symptoms affecting their voice, doctors typically take a closer look for other problems like vocal cord paralysis, GERD (a digestive disorder), and conditions related to brain development. It’s hard to tell how often acute laryngitis happens because a lot of people don’t go to the doctor for it – it often gets better on its own.
- Acute laryngitis typically affects adults between the ages of 18 and 40, but can occur at any age.
- Children as young as 3 can also be affected by this condition.
- For children under 3 with voice symptoms, further investigation into potential conditions such as vocal cord paralysis, GERD, and neurodevelopmental conditions is often carried out.
- The exact rate of occurrences is unknown, as many patients don’t seek medical care because the condition usually improves on its own.
Signs and Symptoms of Acute Laryngitis (Laryngitis)
When a patient comes in with suspected acute laryngitis, doctors look at their overall medical history and give them a physical exam. They look for things like signs of a recent infection, allergy and travel history, and any chronic illnesses like acid reflux disease. They pay close attention to when symptoms started, how long they’ve lasted, and if the patient has had them before. If the patient tried any treatments before visiting the doctor, they also examine how effective these were.
Acute laryngitis generally starts suddenly and gets worse over two or three days. Without treatment, symptoms can last up to a week. Here are the common signs:
- Change in the sound of your voice, which can eventually result in lost voice
- Throat discomfort and pain, especially after talking
- Difficulty swallowing, or pain during swallowing: if this is present, be careful because it could suggest another medical problem
- Dry cough
- General throat dryness, feeling unwell, and possibly a fever
- Feeling the need to clear your throat often
- Early voice weariness or losing vocal range
Diagnoses are typically made based on the patient’s history. A larynx exam can confirm the disease. Using a mirror or a flexible laryngoscope, doctors can look indirectly at the airway. The appearance of the larynx can change depending on how severe the disease is. At the beginning, there could be redness and swelling of the epiglottis, parts of the larynx and vocal cords. As the disease progresses, the vocal cords can become red and swollen. There may also be thick, stringy secretions seen between the vocal cords. If the voice has been excessively used or misused, changes can be seen in the vocal folds. Swelling of the vocal folds is common in both acute and chronic laryngitis. Blood below the fold’s cover might be seen in acute vocal trauma. It’s also possible to find nodules or pseudo-nodules that haven’t been diagnosed before. These could all progress to chronic voice disease if not treated.
Testing for Acute Laryngitis (Laryngitis)
The diagnosis of a medical condition usually starts with a detailed review of the patient’s medical history and a thorough physical examination. Specialized techniques such as formal voice analysis and fiberoptic laryngoscopy, which uses a tiny camera to examine the voice box, can also confirm a diagnosis, particularly in tricky cases that don’t respond to treatment.
Stroboscopy, a procedure that uses strobe light to capture video of vocal cord vibrations, might show irregularities like uneven movement (asymmetry), unpredictable vibration patterns (aperiodicity), and reduced waves of movement from the vocal cord lining (mucosal wave patterns).
Usually, additional imaging tests or laboratory studies aren’t needed, unless there’s suspicion of a less common disease-causing agent or a tumor. In rare cases, when there is a discharge or coating (exudate) in the back of the throat or on the voice box, a culture test might be necessary to identify any possible infection.
Treatment Options for Acute Laryngitis (Laryngitis)
Treating laryngitis often involves supportive methods and depends on how severe the condition is. Here are some of the treatment options:
Voice rest: This is critically important. Speaking during laryngitis may slow down recovery or prevent it from happening entirely. It’s advised to stay completely silent if possible. If the patient must speak, they should use a low volume and avoid whispering or shouting.
Steam Inhalation: Breathing in humidified air can add moisture to the upper airway and help clear secretions.
Avoiding irritants: Habits like smoking and drinking alcohol should be avoided during laryngitis as they can delay recovery.
Diet changes: Those with gastroesophageal reflux disease should limit certain foods that can worsen the condition. This includes avoiding caffeinated beverages, spicy food, fatty food, chocolate, and peppermint. Eating meals at least 3 hours before sleeping and drinking a lot of water can also help. However, the effectiveness of these measures for laryngitis caused by reflux is disputed.
Medications: Antibiotics aren’t typically recommended for otherwise healthy laryngitis patients. However, in severe cases or for patients with other health risks, antibiotics may be prescribed. If a fungal infection is confirmed, it can be treated with oral antifungal medications, typically for a three-week period. Mucolytics such as guaifenesin can also be used to help clear secretions.
For laryngitis caused by reflux disease, anti-reflux medications can be helpful. These include drugs that lower the production of stomach acid. Proton pump inhibitors are found to be most effective, though they may require higher doses or taking twice daily. Antihistamines and oral corticosteroids, however, aren’t generally recommended for treating acute laryngitis.
What else can Acute Laryngitis (Laryngitis) be?
When your throat is sore and your voice is hoarse, you might be dealing with acute laryngitis. However, doctors also need to consider other conditions that might cause these symptoms such as:
- Spasmodic dysphonia (a voice disorder characterized by sudden involuntary muscle movements or spasms)
- Reflux laryngitis (inflammation of the voice box due to stomach acid backflow)
- Chronic allergic laryngitis (persistent inflammation caused by allergies)
- Epiglottitis (swelling of the windpipe)
- Neoplasm (abnormal growth of tissue, a result of either benign or malignant conditions)
Remember, just because your symptoms seem obviously linked to a certain condition, it doesn’t necessarily mean that’s what you actually have. Only a clinician can accurately diagnose your ailment after carrying out the appropriate tests.
What to expect with Acute Laryngitis (Laryngitis)
This condition often resolves itself and has a very good outlook. If the patient follows the recommended treatment, chances are excellent for regaining their normal voice. However, if vocal habits have been adversely changed, speech therapy might be needed to rectify these issues.
