CONDITIONS

Laryngitis

What Is Laryngitis

The larynx (pronounced ‘lair-inks”), also called the voice box, houses the vocal cords. The latter are two small folds of mucous membrane encasing cartilage and muscle that vibrates—giving voice to well, our voice! Normally the vocal cords open and close smoothly, paving the way for us to talk, whisper, shout and/or sing. Any change in the airflow, which is generated by the lungs exhaling air across the vocal cords, affects the voice and quality of sound.

When the larynx is inflamed—the result of over-use, irritation, or infection—the illness called laryngitis occurs. This makes the voice hoarse, raspy or too soft to hear. The inflammation can also cause a sore throat, mild fever, and headache. Laryngitis typically manifests quickly and is short term. When it lasts longer than two or three weeks, however, it is considered chronic and may be caused by more severe problems.

What Causes Laryngitis

There are two types of laryngitis – acute and chronic.

Acute laryngitis is temporary, typically lasting two weeks or less. The causes include:

  • Vocal strain that occurs from yelling or overusing your voice. Think about this the next time you’re loudly cheering on your favorite ball team!
  • Viral infections similar to those that cause a cold
  • Diphtheria a bacterial infections. This is very rare

Mechanical laryngitis is another type of acute laryngitis. This can be caused by:

  • A throat injury
  • Persistent coughing and throat clearing
  • Over-using your voice, AKA by excessive singing, speaking or shouting

Chronic laryngitis is caused by lifestyle factors. These include:

  • Acid Reflux, also known as GERD (gastro esophageal reflux disease). This condition causes acid to leak back up to the throat
  • Frequent exposure to harmful chemicals or allergens
  • Irritation. This can occur from smoking or frequently being around smokers. Allergies can also be a culprit
  • Frequent sinus infections
  • Excessive coughing
  • Frequent use of inhaled steroid medications, such as an asthma inhaler

Other causes of chronic hoarseness and sore throat other than chronic laryngitis could be paralysis of the vocal cords, cancer, or the changes of the shape of the vocal cord that can occur with age.

Risk Factors For Laryngitis

There are various risk factors that can predispose you to be more likely to get laryngitis. These include:

  • Having a respiratory infection like a cold, bronchitis, sinusitis, or allergies.
  • Over-using your voice. If you are a public speaker or practicing to audition for The Voice, be forewarned!
  • Being exposed to irritants such as cigarette smoke, excessive drinking, bulimia, acid reflux, or workplace chemicals

Diagnosing Laryngitis

Diagnosis of laryngitis is done via physical exam that includes feeling your neck for sensitive areas or lumps and checking your throat, nose, and mouth. If you have voice problems and hoarseness that don’t have an obvious cause and that last longer than 2 weeks, your doctor may refer you to a specialist known as an otolaryngologist. The way your vocal cords feel to you often makes it pretty obvious that you have laryngitis, and to your doctor the way your vocal cords look, along with the sound of your voice, will help the specialist see if your laryngitis will go away on its own, or if you need treatment.

With acute laryngitis treatment typically is not needed as it improves on its own. Rest your voice and drink plenty of fluids, though not alcohol or caffeine

Visiting a GP is necessary only for chronic laryngitis, and can be diagnosed with a physical exam, which involves feeling your neck for sensitive areas or lumps as well as checking your nose, mouth and throat. The doctor will ask about your lifestyle—whether and how much you smoke and/or drink, if you are exposed to chemicals and/or dust at work, whether you engage in activities that require shouting and/or constant talking. The doctor will also ask what prescription medications you take and if you have had recent surgery or trauma to the throat


In more severe cases—voice problems and hoarseness that don’t have an obvious cause and last two to three weeks, a laryngoscopy may be performed. A laryngoscopy allows the doctor to find the cause of voice problems such as chronic laryngitis, as it allows your physician to look at the back of your throat, voice box (larynx) and vocal cords with a scope called a laryngoscope.

There are two types of laryngoscopies:

Indirect laryngoscopy. The doctor shines a light in your mouth while wearing either a mirror on his or her head or headgear with a bright light. The purpose is to reflect light to the back of the throat

Direct fiber-optic (flexible or rigid) laryngoscopy. This type is done more frequently than indirect laryngoscopy as it allows the doctor to see deeper into your throat. The scope is either flexible or rigid. A direct rigid laryngoscopy can collect tissue samples (biopsy). Before having this procedure tell your doctor what medications you are taking; if you are allergic to any medications, including anesthetics; have heart problems; take blood thinning medicine such as Coumadin; or have had surgery or radiation treatments to your mouth or throat.

A direct rigid laryngoscopy is performed by an ENT (Ear, Nose and Throat specialist). You shouldn’t eat or drink for eight hours before the test. A general anesthetic is administered for the test, so someone else should drive your home afterward. This procedure takes 15 to 30 minutes, a bit longer than other types of laryngoscopies.

If a biopsy was taken, it is normal to spit up a small amount of blood. Ask the doctor what is normal and how long it might last. If the bleeding lasts for 24 hours, or if there is a lot of bleeding, or you have any trouble breathing, please seek help.

Both an indirect laryngoscopy and direct flexible laryngoscopy can be done in a doctor’s office; the procedure should take just five to ten minutes.

 

Symptoms of Laryngitis

When the laryngitis is infectious, symptoms include:

• Hoarseness and raspiness. You may lose your voice entirely
• Your voice tires easily, breaks or cracks
• Upper respiratory tract infection or cold
• Dry cough
• Fever
• Sore throat
• Runny nose
• Pain when swallowing
• Feeling of fullness or tickle in throat or neck

When the laryngitis is not infectious, symptoms include:

• Cough along with the hoarseness
• Feeling of fullness in the throat
• Difficulty swallowing
• Shortness of breath

Prognosis

Acute laryngitis is typically caused by an acute upper respiratory infection such as cold or flu and should dissipate on its own within a couple of weeks. Acute laryngitis caused by over-using your voice or irritants such as excessive smoking or excessive drinking can also improve if you stop aggravating the condition

However, chronic laryngitis can be more problematic. If it is caused by a treatable condition such as acid reflux or an allergy it can improve. Indeed, studies found that two-thirds of laryngitis sufferers with Acid Reflux who subsequently made dietary changes and took medications were cured. Chronic laryngitis can also reoccur with people who habitually over-use their voice, such as singers or public speakers, and they too must make lifestyle changes to arrest this condition

If chronic laryngitis sufferers continue exposing themselves to factors that aggravate the larynx, small nodules or polyps (fingerlike growths) may develop on the vocal cords. Surgery is necessary to remove these growths

If the chronic laryngitis is the result of a serious condition such as a tumor on the voice box (laryngeal carcinoma) or laryngeal papilloma on the vocal folds, the laryngitis may last weeks or months. If there is permanent damage to the larynx the hoarseness can become permanent

Living With Laryngitis

Here are strategies that can help you deal with laryngitis:

Stop smoking. Also avoid second hand smoke
Drink herbal tea. This can help reduce the severity and duration of the symptoms. Highly recommended are peppermint, rosehip and chamomile – or a combination of all these teas
Gargle with salt. Add sea salt to warm water, melt the salt, and add cold water until the water becomes lukewarm. Drink some water, gargle a few seconds, spit out the water. Repeat this process a few times. This gargling with salt remedy can be repeated several times a day to relieve a sore throat that comes along with laryngitis
Garlic and honey. While it might seem like an odd pairing, these two ingredients together are a helpful remedy. Grate or crush several cloves of garlic and add them to a small cup. Add raw honey and mix. Taking a teaspoon an hour or when symptoms are most severe can be relieving – feel free to swallow quickly!

Prevention

There are several steps you can take to prevent laryngitis:

  • Don’t smoke and avoid secondhand smoke
  • Use a humidifier to add air to your home
  •  Take protective measures to limit your exposure to irritating chemicals and dusts
  •  Avoid long bouts of uninterrupted talking and shouting
  • Practice good hygiene such as washing your hands to avoid contracting viruses such as the common cold
  • Avoid clearing the throat
  • Avoid upper respiratory infections
  • Limit consumption of alcohol and caffeine

Common Treatment

For acute laryngitis, self care should be sufficient:

  • Rest your voice
  • Drink lots of fluids, avoiding caffeine and alcohol, which can irritate the throat
  • Don’t smoke and avoid second hand smoke
  • Suck on lozenges
  • Breathe humidified air
  • Avoid decongestants – these can dry out the throat
  •  Take ibuprofen to help with inflammation and pain
  • Avoid whispering as it strains the voice
  • For laryngitis caused by Acid Reflex, avoid triggers such as acidic juices, spicy or fatty foods and caffeine
  • Breathe through your nose only. This helps the larynx not be exposed to cold air, as happens when you breathe through the mouth

For cases of chronic laryngitis, the underlying cause such as heartburn, excessive smoking or drinking, need to be addressed. Here are some suggestions:

  • Get vocal therapy. This involves having the way you use your voice analyzed to diagnose and correct speech patterns which put stress on the vocal cords and box
  • Quit smoking, limit your drinking
  • Avoid inhaling irritants such as chemical fumes

Medications are rarely used for treatment of laryngitis, although if the cause is bacterial, an antibiotic might be prescribed. If the laryngitis is the result of allergies, antihistamines or inhaled steroids may be prescribed.

Complementary and Alternative Treatment

These natural remedies are in addition to the traditional ones described above:

Slippery Elm. This Native American remedy contains mucilage, a gel-like substance that calms irritated or inflamed tissue. Look for teas or lozenges with slippery elm as an ingredient
Mullein. This herb soothes the respiratory tract. It is also available in tea and lozenge form
The licorice root. This contains glycyrrhizin, an anti-inflammatory
Elderflower. This herb contains anti-viral properties

When To Contact A Doctor

Contact a doctor if:

• You have a history of throat or breathing problems
• The hoarseness lasts two to three weeks even though you’ve been resting your voice
• You have throat pain
• There is swelling in your neck
• You can’t swallow liquids
• There is high fever and a sore throat
• You are coughing up yellow or green phlegm – this can be indicative of sinusitis or bronchitis

Questions For A Doctor

Your first step is likely your general practioner, although you might ultimately be referred to an ENT.
Pre-appointment, write down a list of things you want him or her to know as well as questions you’d like to have answered. For instance:

• Discuss any symptoms you are having, even if they don’t seem related to laryngitis
• Give the doctor a list of the medications, vitamins and supplements you take
• Write down important personal information such as recent major life changes and/or stressors

Ask questions, such as:

• What is likely causing the laryngitis?
• What are other possible causes?
• What is the best course of action?
• Is my condition likely temporary or chronic?
• I have other health conditions. How can I manage them together?
• Should I see a subspecialist?
• What tests should I have, if any?
• Are there websites or printed material you recommend I read?

Resources

 

The Voice Foundation offers comprehensive information about laryngitis.