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Laryngitis: Causes, Symptoms, and Evidence-Based Treatment

Laryngitis: Acute & Chronic Vocal Fold Inflammation

Laryngitis is inflammation of the laryngeal mucosa and vocal folds, causing voice changes (hoarseness, aphonia).

Etiology

  • Acute (≤3 weeks):
    • Viral URI (rhinovirus, influenza, parainfluenza, RSV) — most common.
    • Vocal overuse/misuse (shouting, singing, teaching).
    • Irritants: smoke, pollution, chemical fumes, alcohol.
    • Bacterial (rare): M. catarrhalis, H. influenzae, S. pneumoniae.
  • Chronic (>3 weeks):
    • Laryngopharyngeal reflux (LPR) — major cause.
    • Chronic vocal abuse (teachers, singers, coaches).
    • Smoking/alcohol.
    • Inhaled corticosteroids (oral thrush → laryngeal irritation).
    • Autoimmune (RA, SLE, granulomatosis with polyangiitis).
    • Neoplasm (rule out if persistent >2–3 wks, especially smokers).

Symptoms

  • Hoarseness, breathiness, voice fatigue, pitch breaks.
  • Sore throat, dry cough, throat clearing, globus sensation.
  • Dysphagia, odynophagia (if infectious).
  • Fever, malaise (viral).

Diagnosis

  • History + laryngoscopy (flexible/rigid): erythema, edema, vascular dilation, lesions.
  • Stroboscopy for vibratory analysis (voice professionals).
  • Rule out malignancy if risk factors + persistent symptoms.

Treatment

  1. Voice Rest / Hygiene: Relative voice rest (not whispering — increases strain). Hydration (2–3 L/day). Humidification. Avoid irritants.
  2. Treat Underlying Cause:
    • LPR: PPI BID 30 min before meals + lifestyle (head elevation, no late meals, avoid triggers).
    • Viral: supportive; antivirals if influenza early.
    • Bacterial: antibiotics if evidence (rare).
    • Allergic: intranasal steroids, antihistamines.
  3. Symptomatic Relief:
    • Lozenges (glycerin, honey, pectin) — avoid menthol/eucalyptus (drying).
    • Analgesics (acetaminophen/NSAIDs) for pain.
    • Mucolytics (guaifenesin) if thick mucus.
  4. Voice Therapy (SLP): Resonant voice, flow phonation, vocal function exercises — gold standard for chronic/functional.
  5. Corticosteroids (Short Course): Prednisone 30–60 mg × 5–7 days for acute severe inflammation (e.g., performer with imminent event) — not routine.

Red Flags — Refer to ENT

  • Hoarseness >3 weeks (esp. smoker >40).
  • Hemoptysis, stridor, dyspnea, dysphagia, weight loss, otalgia.
  • Neck mass.
  • Professional voice user with career impact.

Most acute laryngitis resolves in 7–14 days with conservative care. Chronic requires addressing root cause (reflux, behavior, environment).

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