Laryngitis

AUTHOR: Glenn G. Fort, MD, MPH

Definition

Laryngitis is an acute or chronic inflammation of the laryngeal mucous membranes.

Synonym

Lower respiratory tract infection

ICD-10CM CODES
J04.0		Acute laryngitis
J37.0		Chronic laryngitis

Epidemiology & Demographics

It is a common illness worldwide in both sexes and all age groups, but the diagnosis is imprecise, and therefore statistics are not readily available with respect to incidence and prevalence.

Physical Findings & Clinical Presentation

Acute Laryngitis

Clinical syndrome characterized by the onset of hoarseness, voice breaks, or episodes of aphonia; also may have accompanying sore throat, cough, nasal congestion, and rhinorrhea
Usually associated with viral upper respiratory tract infection
Larynx with diffuse erythema, edema, and vascular engorgement of the vocal folds, and occasionally mucosal ulceration
In young children, subglottis is often affected, resulting in airway narrowing with marked hoarseness, inspiratory stridor, dyspnea, and restlessness
Respiratory compromise rare in adults

Chronic Laryngitis

Characterized by hoarseness or dysphonia persisting for longer than 2 wk.

Etiology

Acute Laryngitis

Most often caused by viruses, so treatment consists of supportive measures as outlined in “Nonpharmacologic Therapy” section.
Studies evaluating the use of antibiotics (erythromycin, penicillin) in acute laryngitis failed to show objective clinical benefit over placebo, so they are not routinely recommended. Antibiotics and other antimicrobials may be indicated in cases in which specific treatable pathogens are identified.
Avoid decongestants because of their drying effect.
Guaifenesin may be a useful adjunct as a mucolytic agent.
In gastroesophageal reflux disease (GERD)-associated laryngitis use acid-suppressive therapy (H₂ blockers, proton pump inhibitors) and nocturnal antireflux precautions.

Chronic Laryngitis

Results from any of the following: Tuberculosis, usually through bronchogenic spread; leprosy, from nasopharyngeal or oropharyngeal spread; syphilis, in secondary and tertiary stages; rhinoscleroma, extending from the nose and nasopharynx; actinomycosis; cryptococcosis; histoplasmosis; blastomycosis; paracoccidioidomycosis; coccidiosis; candidiasis; aspergillosis; sporotrichosis; rhinosporidiosis; parasitic infections including leishmaniasis and clinostomum infection following raw fresh-water fish ingestion.
Noninfectious causes of both acute and chronic laryngitis include malignancy, voice abuse (singers), GERD, and chemical or environmental irritants such as cigarettes and allergens. Other causes of inflammatory or granulomatous lesions of the larynx include relapsing polychondritis, Wegener granulomatosis, and sarcoidosis.

Diagnosis ⬆ ⬇

Differential Diagnosis

Young children with signs of airway obstruction:
1. Supraglottitis (epiglottitis)
2. Laryngotracheobronchitis
3. Tracheitis
4. Foreign body aspiration
In adults with persistent hoarseness, consider noninfectious causes of laryngitis as listed previously.
Table E1 summarizes the classification and definition of infectious illnesses involving the larynx and supraglottic and infraglottic regions.

TABLE E1 Classification and Definition of Infectious Illnesses Involving the Larynx and Supraglottic and Infraglottic Regions

Category	Other Terms	Definitions
Supraglottitis	Epiglottitis	Infection of the epiglottis and/or arytenoid epiglottic folds and ventricular bands of the base of the epiglottis, resulting in swelling and upper airway obstruction
Laryngitis		Inflammation of larynx resulting in hoarseness; usually occurs in older children and adults in association with common upper respiratory viral infections
Laryngeal diphtheria	Membranous croup, true croup, diphtheritic croup	Infection involving larynx and other areas of upper and lower airway due to Corynebacterium diphtheriae, resulting in gradually progressive obstruction of airway and associated inspiratory stridor
Laryngotracheitis	False croup, virus croup, acute obstructive subglottic laryngitis	Inflammation of larynx and trachea most often caused by infection with parainfluenza and influenza viruses
Laryngotracheobronchitis and laryngotracheobronchopneumonitis	Membranous laryngotracheobronchitis, pseudomembranous croup	Inflammation of larynx, trachea, and bronchi or lung or all three; usually similar in onset to laryngotracheitis, but a more severe illness; bacterial infection frequently has causative role
Bacterial croup	Bacterial tracheitis, membranous croup, membranous tracheitis, membranous laryngotracheobronchitis, pseudomembranous croup	Severe form of laryngotracheitis, laryngotracheobronchitis, or laryngotracheobronchopneumonitis due to bacterial infection
Spasmodic croup	Spasmodic laryngitis, catarrhal spasm of the larynx, subglottic allergic edema	Illness characterized by sudden nighttime onset of inspiratory stridor; associated with mild upper respiratory infection without inflammation or fever but with edema in subglottic region

From Cherry JD et al: Feigin and Cherry’s pediatric infectious diseases, ed 8, Philadelphia, 2019, Elsevier.

Workup

History and physical examination: Diagnosis is usually apparent.
Laryngoscopy for severe or persistent cases.
Laryngeal cultures should be performed if a cause other than acute viral infection is suspected.
Imaging not indicated unless there is evidence of airway compromise. Obtain plain radiographs of neck, anteroposterior and lateral views, to differentiate laryngitis from acute laryngotracheobronchitis or supraglottitis.

Treatment ⬆ ⬇

Nonpharmacologic Therapy

Rest the voice.
Use an air humidifier.
Ensure adequate hydration. Avoid alcohol and caffeine because of diuretic effect.

Acute General Rx

Antibiotics and other antimicrobials generally should not be used. They are indicated only when a specific pathogen is isolated; commonly employed antibacterial agents are macrolides; clarithromycin 500 mg by mouth bid for 5 to 7 days or azithromycin 500 mg followed by 250 mg once daily for 4 to 5 days if the cause of laryngitis is found to be Mycoplasma pneumoniae or Chlamydophila pneumoniae (the new name for what was formerly known as Chlamydia pneumoniae).
Avoid decongestants because of their drying effect.
Guaifenesin may be a useful adjunct as a mucolytic agent.
In GERD-associated laryngitis use acid-suppressive therapy (H₂ blockers, proton pump inhibitors) and nocturnal antireflux precautions.

Disposition

Uncomplicated laryngitis is usually benign, with gradual resolution of symptoms.

Referral

If symptoms persist for >2 wk, refer to otolaryngologist for laryngoscopy.
Consider referral to gastroenterologist if GERD is suspected.

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Basic Information ⬇

Diagnosis ⬆ ⬇

Treatment ⬆ ⬇

Pearls & Considerations ⬆ ⬇

Suggested Readings ⬆