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laryngitis

Inflammation of the larynx. Etiology: 1) infectious: a) acute (symptoms < 2 to 3 weeks) - viral - influenza A & B - parainfluenza - adenovirus - rhinovirus - coronavirus - Epstein-Barr virus (EBV) - generally in association - bacterial - Mycoplasma pneumonia - Chlamydia - Haemophilus influenza (epiglottitis) - secondary to pharyngitis, tonsillitis, sinusitis - Streptococcus pneumonia - Staphylococcus aureus - Streptococcus, group A - Moraxella catarrhalis - Corynebacterium diphtheriae (in association with pharyngitis) b) chronic (symptoms over months to years) - bacterial - tuberculosis - leprosy (rare) - syphilis (particulary secondary & tertiary) - rhinoscleroma - actinomycosis - fungal - histoplasmosis - blastomycosis - candidiasis (generally in association with esophageal or disseminated candidiasis) 2) inflammatory (non-infectious) a) excessive use of the voice can lead to vocal cord nodules or singer's nodules b) gastroesophageal reflux, (see laryngopharyngeal reflux) c) exposure to irritants - tobacco smoke - alcohol - chemicals: acids, petroleum fumes - acute thermal injury - smoke inhalation - steam injury - radiation injury d) endotracheal intubation Clinical manifestations: 1) acute or indolent onset 2) sore throat, but pain may also be referred to the ear 3) hoarseness, sore throat, rhinorrhea 4) dry cough, generally without sputum 5) loss of voice, dysphonia or aberration in voice quality 6) dyspnea, stridor, dysphagia & odynophagia a) late symptoms b) suggest more serious disease 7) fever may be present Physical examination: 1) adenopathy 2) gag reflex & swallowing reflex 3) signs of inflammation of the pharynx, sinuses or lungs 4) focal neurologic findings Laboratory: (selected tests which may be indicated) 1) complete blood count (CBC) with differential 2) culture from throat or larynx 3) blood cultures if indicated 4) rheumatoid factor 5) C1 esterase Special laboratory: 1) indirect (mirror) or fiberoptic laryngoscopy to assess for: a) laryngeal mucosa ulcers, edema or erythema b) mass lesions c) vocal cord dysfunction d) structural abnormalities 2) laryngeal biopsy via direct laryngoscopy Differential diagnosis: 1) vocal cord dysfunction - recurrent laryngeal nerve &/or superior laryngeal nerve dysfunction 2) neoplasms of the larynx a) papilloma (benign; juvenile & adult forms) b) squamous cell carcinoma 1] generally in patients age 50-70 2] increased risk associated with alcohol & tobacco 3) systemic disorders that affect the larynx a) sarcoidosis b) amyloidosis c) systemic lupus erythematosus d) rheumatoid arthritis of cricoarytenoid joint e) allergic angioedema f) acromegaly g) myxedema h) pemphigus vulgaris 4) functional disorders a) psychogenic aphonia (history of emotional disturbance) b) vocal weakness 1] generally seen in the elderly 2] lack of usual vigor or tone to voice 3] results from vocal cord bowing & muscle atrophy 4] part of normal aging process 5) peritonsillar abscess: - dysphagia, trismus (lockjaw) - asymmetric swelling of peritonsillar area 6) mononucleosis: hoarseness uncommon 7) tonsillitis: - enlarged tonsils - voice changes uncommon but may be painful to speak [4] 8) Ludwig's angina: slurred speech, not hoarseness Management: 1) for most cases of acute laryngitis, the voice eventually returns to baseline spontaneously 2) non-pharmaceutical measures a) voice rest b) eliminate clearing of throat c) humidification & hydration 3) cough suppression 4) relief of nasal obstruction - pseudoephedrine 5) treatment of gastroesophageal reflux a) high-dose cimetidine, ranitidine, or famotidine b) omeprazole 6) antibiotics for fever, productive cough or purulent sputum - generally do NOT shorten course of symptoms 7) follow-up a) with conservative management, most patients recover their voice within 2-3 weeks b) 8 weeks may be necessary for GERD-related laryngitis to resolve 8) refer to otolaryngologist for: a) patients with acute laryngitis who do not improve with therapy b) chronic laryngitis of unknown cause

Related

laryngopharyngeal reflux (LPR)

Specific

croup (laryngotracheobronchitis) epiglottitis laryngopharyngitis

General

throat infection; pharyngeal infection; laryngeal infection inflammation laryngeal disease

References

  1. Guide to Physical Examination & History Taking, 6th edition, Bates B, JB Lippincott, Philadelphia, 1995, pg 72
  2. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 108-109
  3. Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
  4. NEJM Knowledge+ Otolaryngology - Jaworek AJ, Earasi K, Lyons KM et al Acute infectious laryngitis: A case series. Ear Nose Throat J. 2018 Sep;97(9):306-313. PMID: 30273430 Free article.