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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.
There are two types of laryngitis – acute and chronic.
Acute laryngitis is temporary, typically lasting two weeks or less. The causes include:
Mechanical laryngitis is another type of acute laryngitis. This can be caused by:
Chronic laryngitis is caused by lifestyle factors. These include:
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.
There are various risk factors that can predispose you to be more likely to get laryngitis. These include:
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.
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
• 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
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
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!
There are several steps you can take to prevent laryngitis:
For acute laryngitis, self care should be sufficient:
For cases of chronic laryngitis, the underlying cause such as heartburn, excessive smoking or drinking, need to be addressed. Here are some suggestions:
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.
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
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
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?
The Voice Foundation offers comprehensive information about laryngitis.
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