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Laryngitis facts

- Laryngitis is an inflammation of the voice box.

- Causes of laryngitis include upper or cold; excess talking, singing, or shouting; reflux laryngitis; chronic irritation of the vocal cords; or stroke.

- Laryngitis is contagious if it is caused by an infection.

- The most common symptoms of laryngitis are hoarseness, loss of voice, and throat pain.

- Symptoms of laryngitis in adults include cough, sore, fever, swollen lymph nodes, pain with swallowing, and a feeling of fullness in the throat or neck.

- Symptoms of laryngitis in infants in children include croup, hoarse barky cough, and fever.
Chronic laryngitis, in which the symptoms last for weeks, may be caused by by gastroesophageal reflux disease, smoking, or alcohol use.

- Chronic inflammation due to laryngitis may cause nodules or polyps to form on the vocal cords.

- Treatment of laryngitis is usually symptomatic, home remedies, and resting the voice.
If symptoms of laryngitis persist for more than a couple of weeks, further testing may be recommended.

- Complications of laryngitis include pneumonia, GERD, chronic bronchitis, or vocal chord paralysis.

What is laryngitis?

The larynx is the voice box that allows us to speak, shout, whisper, and sing. The larynx consists of a cartilage skeleton that houses the vocal cords that are covered by a mucus lining. Muscles inside the larynx adjust the position, shape, and tension of the vocal cords, allowing us to make different sounds from whispering to singing. Any change in the air flow (which is generated by the lungs exhaling air) across the vocal cords will affect the voice and the quality of the sound.

The larynx is located at the junction of the mouth and trachea and has a flap-like covering called the epiglottis, whose job it is to prevent food and saliva from entering the larynx during swallowing.

Laryngitis (larynx + itis = inflammation) is an inflammation of the voice box, causing a person to lose their voice. The quality of the voice becomes hoarse or gravelly-sounding or even too quiet or soft to hear.




What causes Laryngitis?

- Laryngitis is an inflammation of the vocal cords. Most commonly, acute laryngitis is caused by an infection that inflames the vocal cords.

- Laryngitis may also be caused by voice overuse with excess talking, singing, or shouting.

- Chronic laryngitis, often described as lasting for more than three weeks, may be caused by prolonged alcohol use, smoking, and excess coughing.

- Gastroesophageal reflux disease (GERD) may cause laryngeal inflammation and chronic cough, if acid and digestive juices from the stomach reflux up into the oesophagus and back of the throat. Sometimes people are aware of the presence of the acid and experience waterbrash, a sour taste in their mouth. Repeat spills of acid onto the vocal cords will cause a chemical irritation and result in inflammation of the vocal cords that hinders appropriate vibration and generation of sound.

- Chronic irritation of the vocal cords may also cause polyps or nodules to form on the vocal cords, which may affect the ability of the vocal cords to vibrate causing hoarseness.

- Stroke may also cause vocal cord muscle paralysis and lead to a weak, hoarse voice and swallowing problems.

- Damage to the muscles or to the nerves that control them may lead to hoarseness. These nerves may be damaged if there has been trauma to the neck or if surgery has been performed and the nerves inadvertently irritated or severed.

- Tumours in the neck and chest may compress the nerves and cause them to function poorly.

- Thyroid inflammation and enlargement can also cause irritation of nerves that supply the vocal cord muscles.

- Not all individuals who have lost their voice have an infection.

- Diphtheria is rarely a cause of laryngitis-like symptoms because most people are immunized and protected against this infection.

What are the symptoms of laryngitis?

Hoarseness, loss of voice, and throat pain are the primary symptoms of laryngitis.

Symptoms of laryngitis in adults

If the cause of laryngitis is infectious, affected individuals will have symptoms of:

- Upper respiratory tract infection or cold
- Dry cough
- Sore throat
- Fever
- Swollen lymph nodes (lymph glands) in the neck
- Pain with swallowing
- A feeling of fullness in the throat or neck
- Runny nose
- Loss of voice
- Symptoms of laryngitis in infants and young children

Air is brought into our lungs like a bellows, sucking air in through the mouth. In children with croup, there also may be difficulty breathing. As the child tries to breathe through a swollen and narrow larynx, the cartilage may collapse, just like when attempting to breathe through a straw. As we age, the cartilage becomes stiffer and is able to withstand deeply indrawn breaths, but in children the cartilage is weaker and with each inspiration, the child may need to work hard to inhale.

In infants and young children, the classic signs and symptoms of an inflamed larynx caused by infection include:

- croup,
- a hoarse barky cough, and
- Fever.

Other symptoms of laryngitis

When the cause of laryngitis is not infectious, cough may be a significant symptom along with the hoarseness.

Is laryngitis contagious?

Laryngitis is contagious if it is caused by an infection. If a respiratory infection or cold is caused by an infection, they are contagious. Laryngitis, upper respiratory infections, and colds are commonly a viral infection spread by aerosol droplets.

Covering the nose and mouth when coughing and sneezing, and proper hygiene habits (for example, washing the hands often) help prevent transmission of viruses.

How is laryngitis diagnosed?

The health care practitioner can often diagnose laryngitis quickly at the doctor's office. The history of upper respiratory tract infection associated with loss of voice is reinforced by the patient answering questions in a hoarse voice. The examination is often brief and limited to the ears, nose, and throat, looking for other potential causes of the cold-like symptoms. If the throat is red and there is a concern about a strep throat in addition to the laryngitis, a throat swab for a screen may be done.

If the hoarse voice becomes chronic, the health care practitioner may want to take a more detailed history, accessing reasons why the larynx and vocal cords have become inflamed for a prolonged period of time.

Questions may be asked about:

- Diet, use of alcohol, aspirin, ibuprofen, and smoking, all of which may cause gastroesophageal reflux disease. Alcohol and smoking can irritate the vocal cords.

- Work and hobbies may reveal evidence of repeated chemical inhalation and exposure.

- Exploration in regard to whether there may be disease, symptoms, or cancers of the head and neck.

Most cases of laryngitis need no testing to confirm the diagnosis. In those patients with chronic laryngitis, the necessity for blood tests X-rays and other diagnostic tests will depend upon the patient presentation and the potential concerns that the health care practitioner has regarding the cause of the hoarseness.

Laryngoscopy is the most common test performed to look directly at the vocal cords and evaluate their function. Using a thin tube containing a lighted fiberoptic camera inserted through the nose into the back of the throat, an otolaryngologist (ear, nose, and throat specialist) can see whether the vocal cords are inflamed, if there are any polyps or nodules growing on them, and if they move appropriately with breathing and speaking.

What is the treatment for laryngitis?

As with any other structure in the body that becomes inflamed, rest is the key to recovery. For laryngitis, this means limiting the amount of talking. If talking is required, the affected individual should avoid whispering and instead talk in a regular voice, regardless of how it sounds. Whispering requires the vocal cords to be stretched tightly and requires more work by the surrounding muscles and delays recovery time.

The treatment for viral laryngitis is supportive: plenty of fluids, humidified air, acetaminophen or ibuprofen for pain, and time for recovery.

For patients with significant laryngitis, a short course of steroids (prednisone, prednisolone, or dexamethasone) may be used to decrease the inflammation and shorten the course of symptoms. This treatment option is often considered for actors, singers, or other affected individuals who have to make a time sensitive presentation using their voice.
Dexamethasone as a single dose given orally (Decadron, DexPak) or by intramuscular injection (Adrenocot, CPC-Cort-D, Decadron Phosphate, Decaject-10, Solurex) may be used to treat croup.
The treatment of chronic laryngitis will be determined by the cause of the inflammation or loss of function. Discontinuation of smoking and alcohol use will have a positive effect.

Are there any home remedies for laryngitis?

It is reasonable not to seek medical care for most cases of laryngitis. Home treatment begins with resting the voice and keeping well hydrated. Symptoms may be controlled by exposure to humidified air. Often, the bathroom is the best place to create a highly humidified area.

Turn on the hot water in the shower until there is plenty of steam.

Make certain that all the hot water is drained from the tub or shower to prevent the risk of burns.

Spend 15- 20 minutes breathing the warm moist air to help with symptoms.
A cold water vaporizer may also be used to help with humidity. Avoid hot water vaporizers because of the risk of burns.

Stay well hydrated, especially if the pain makes it difficult to swallow fluid.

Warm water gargles may be soothing. Alternatively, popsicles may offer comfort.

Tylenol and/or ibuprofen may be helpful in decreasing the amount of pain.

What are the complications of laryngitis?

If the cause of laryngitis is vocal cord paralysis, the swallowing mechanism may also be affected, and food particles may enter the larynx and lungs, leading to coughing. This process can also lead to pneumonia and its accompanying symptoms (fever, cough, shortness of breath) when the food is aspirated deep into the lungs and causes irritation and inflammation of lung tissue.

Repeated episodes of gastroesophageal reflux may cause small amounts of acid to get past the inflamed larynx and enter the lung, causing recurrent pneumonia or bronchitis.

Prior to the advent of Haemophilusinfluenzae immunization, epiglottitis due to this infection was always considered as a possible alternative diagnosis for children with croup. This was a life-threatening medical emergency because the epiglottis could massively swell, blocking air from entering the larynx and lungs. X-rays of the neck may be taken to visualize the epiglottis and look for swelling. The diagnosis was often confirmed in the operating room where the otolaryngologist and anaesthesiologist would use laryngoscopy to look at the epiglottis and vocal cords and decide whether to insert a breathing tube in the child's airway to prevent the airway from swelling shut. Fortunately, because of immunization, this disease is rarely seen.