laryngitis
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Introduction
Inflammation of the larynx.
Etiology
- infectious:
- acute (symptoms < 2 to 3 weeks)
- viral
- influenza A & B
- parainfluenza
- adenovirus
- rhinovirus
- coronavirus
- Epstein-Barr virus (EBV) - generally in association
- bacterial
- viral
- chronic (symptoms over months to years)
- bacterial
- tuberculosis
- leprosy (rare)
- syphilis (particulary secondary & tertiary)
- rhinoscleroma
- actinomycosis
- fungal
- histoplasmosis
- blastomycosis
- candidiasis (generally in association with esophageal or disseminated candidiasis)
- bacterial
- acute (symptoms < 2 to 3 weeks)
- inflammatory (non-infectious)
- excessive use of the voice can lead to vocal cord nodules or singer's nodules
- gastroesophageal reflux, (see laryngopharyngeal reflux)
- exposure to irritants
- tobacco smoke
- alcohol
- chemicals: acids, petroleum fumes
- acute thermal injury
- smoke inhalation
- steam injury
- radiation injury
- endotracheal intubation
Physical examination
- adenopathy
- gag reflex & swallowing reflex
- signs of inflammation of the pharynx, sinuses or lungs
- focal neurologic findings
Clinical manifestations
- acute or indolent onset
- sore throat, but pain may also be referred to the ear
- hoarseness, sore throat, rhinorrhea
- dry cough, generally without sputum
- loss of voice, dysphonia or aberration in voice quality
- dyspnea, stridor, dysphagia & odynophagia
- late symptoms
- suggest more serious disease
- fever may be present
Laboratory
(selected tests which may be indicated)
- complete blood count (CBC) with differential
- culture from throat or larynx
- blood cultures if indicated
- rheumatoid factor
- C1 esterase
Diagnostic procedures
- indirect (mirror) or fiberoptic laryngoscopy to assess for:
- laryngeal mucosa ulcers, edema or erythema
- mass lesions
- vocal cord dysfunction
- structural abnormalities
- laryngeal biopsy via direct laryngoscopy
Differential diagnosis
- vocal cord dysfunction
- recurrent laryngeal nerve &/or superior laryngeal nerve dysfunction
- neoplasms of the larynx
- papilloma (benign; juvenile & adult forms)
- squamous cell carcinoma
- systemic disorders that affect the larynx
- functional disorders
- psychogenic aphonia (history of emotional disturbance)
- vocal weakness
- generally seen in the elderly
- lack of usual vigor or tone to voice
- results from vocal cord bowing & muscle atrophy
- part of normal aging process
- peritonsillar abscess:
- dysphagia, trismus (lockjaw)
- asymmetric swelling of peritonsillar area
- mononucleosis: hoarseness uncommon
- tonsillitis:
- enlarged tonsils
- voice changes uncommon but may be painful to speak[4]
- Ludwig's angina: slurred speech, not hoarseness
Management
- for most cases of acute laryngitis, the voice eventually returns to baseline spontaneously
- non-pharmaceutical measures
- cough suppression
- relief of nasal obstruction - pseudoephedrine
- treatment of gastroesophageal reflux
- high-dose cimetidine, ranitidine, or famotidine
- omeprazole
- antibiotics for fever, productive cough or purulent sputum
- generally do NOT shorten course of symptoms
- follow-up
- refer to otolaryngologist for:
- patients with acute laryngitis who do not improve with therapy
- chronic laryngitis of unknown cause
More general terms
More specific terms
Additional terms
References
- ↑ Guide to Physical Examination & History Taking, 6th edition, Bates B, JB Lippincott, Philadelphia, 1995, pg 72
- ↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 108-109
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
- ↑ 4.0 4.1 NEJM Knowledge+ Otolaryngology
Jaworek AJ, Earasi K, Lyons KM et al Acute infectious laryngitis: A case series. Ear Nose Throat J. 2018 Sep;97(9):306-313. PMID: https://www.ncbi.nlm.nih.gov/pubmed/30273430 Free article.