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Monday, August 11, 2025

Laryngitis


Definition
Laryngitis is the inflammation of the larynx, usually presenting with hoarseness, loss of voice, and throat discomfort. It can be acute (lasting less than 3 weeks) or chronic (lasting longer than 3 weeks). The condition results from irritation, infection, or overuse of the vocal cords.

Causes

Acute Laryngitis

  • Viral infections (most common) – rhinovirus, influenza virus, parainfluenza virus, adenovirus.

  • Bacterial infections – Streptococcus pyogenes, Haemophilus influenzae, Moraxella catarrhalis (less common).

  • Vocal overuse or shouting.

  • Inhalation of irritants (smoke, chemicals).

Chronic Laryngitis

  • Persistent exposure to irritants (smoking, alcohol, dust).

  • Gastroesophageal reflux disease (GERD).

  • Chronic sinusitis with postnasal drip.

  • Repeated vocal strain (singers, teachers).

  • Allergies.

Clinical Presentation

  • Hoarseness or loss of voice.

  • Sore or dry throat.

  • Weak voice or voice fatigue.

  • Dry cough.

  • Tickling sensation in the throat.

  • In bacterial or severe cases: fever, odynophagia (painful swallowing).

Diagnosis

Clinical evaluation is usually sufficient for acute cases.
Investigations may include:

  • Laryngoscopy for chronic or atypical cases.

  • Throat swab if bacterial infection suspected.

  • Reflux assessment in chronic GERD-associated cases.

Management

General Principles

  • Most acute cases resolve spontaneously within 7–10 days.

  • Voice rest is essential to prevent strain and promote healing.

  • Avoid irritants such as smoke and alcohol.

  • Adequate hydration to keep mucosa moist.

  • Use of humidifiers in dry environments.

Pharmacological Treatment

Viral Laryngitis (most common)

  • Symptomatic treatment; no antibiotics needed.

Bacterial Laryngitis (suspected or confirmed)

  • Amoxicillin: 500 mg orally every 8 hours for 7–10 days.

  • Clarithromycin: 250–500 mg orally every 12 hours for 7 days (alternative in penicillin allergy).

  • Azithromycin: 500 mg on day 1, then 250 mg once daily for 4 days (alternative).

Pain Relief and Inflammation

  • Paracetamol: 500–1000 mg orally every 4–6 hours as needed (max 4 g/day).

  • Ibuprofen: 400 mg orally every 6–8 hours as needed (max 2400 mg/day).

GERD-Associated Laryngitis

  • Omeprazole: 20–40 mg orally once daily before breakfast for 4–8 weeks.

  • Lansoprazole: 30 mg orally once daily before breakfast.

Allergic Component

  • Loratadine: 10 mg orally once daily.

  • Cetirizine: 10 mg orally once daily.

Non-Pharmacological Measures

  • Avoid whispering (puts more strain on vocal cords).

  • Warm saline gargles several times a day.

  • Sucking on lozenges to stimulate saliva production.

  • Steaming or inhalation of warm moist air.

Complications

  • Vocal cord nodules or polyps from chronic strain.

  • Chronic laryngitis leading to persistent voice changes.

  • Secondary bacterial infection.

  • Laryngeal stenosis (rare, usually after severe inflammation).

Prognosis

  • Acute laryngitis generally has an excellent prognosis with full recovery in 1–2 weeks.

  • Chronic cases require identification and management of underlying causes for sustained improvement.




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