Laryngitis

Last reviewed: July 2019

Last updated: July 2019

Summary

Laryngitis is inflammation of the larynx, which can lead to edema of the true vocal folds. Causes may be infectious or noninfectious (e.g., vocal strain, reflux laryngitis, chronic irritative laryngitis).

Generally clinically diagnosed.

Symptoms of acute disease, most commonly hoarseness, generally arise over a period of <7 days, are usually preceded by a viral upper respiratory infection, and are ordinarily self-limiting. Patients may present with airway distress and high fever. Exudative tonsillopharyngitis with fever and anterior cervical lymphadenitis is highly suggestive of a bacterial origin.

The airway should be assessed first. Diligence and promptness are key, as they can be lifesaving.

Chronic laryngitis presents with hoarseness lasting >3 weeks. A thorough evaluation and specialist consultation should be obtained, because symptoms are similar to those of laryngeal malignancy.

Treatment for viral laryngitis consists of voice rest and hydration. For bacterial causes, antibiotics are used along with supportive measures. Vocal strain is managed with voice therapy and vocal hygiene.

Definition

Laryngitis refers to the inflammation of the larynx. This can lead to edema of the true vocal folds, resulting in hoarseness. Laryngitis can be acute or chronic, infectious or noninfectious. Accompanying signs of infectious laryngitis include odynophagia, cough, fever, and respiratory distress. The most common variant is acute viral laryngitis, which is self-limiting and usually related to an upper respiratory infection. Bacterial laryngitis can be life-threatening. Haemophilus influenzae is one of the most frequently isolated bacteria. Other causes include tuberculosis, diphtheria, syphilis, and fungi. Noninfectious causes of laryngitis include reflux laryngitis, vocal strain and chronic irritant laryngitis.

History and exam

Key diagnostic factors

hoarseness
dysphagia
sore throat
odynophagia
cough
hyperemia of the oropharynx
history of heavy vocal use
gastroesophageal reflux
oropharyngeal white-gray exudates

Full details

Other diagnostic factors

rhinitis
fatigue and malaise
fever
enlarged tonsils
enlarged, tender anterior cervical lymph nodes
postnasal drip
dyspnea
weight loss
tonsillopharyngeal exudate
acute respiratory distress
toxic appearance
drooling
stridor

Full details

Risk factors

recent history of upper respiratory infection
incomplete or absent Haemophilus influenzae type B (Hib) vaccination
incomplete or absent diphtheria vaccination
contact with infected individual
travel to area where diphtheria or tuberculosis are endemic
HIV or other immunocompromise
residence in a nursing home
inhaled corticosteroids or prolonged courses of antibiotics
heavy vocal use
tobacco use

Full details

Diagnostic investigations

1st investigations to order

laryngoscopy

Full details

Investigations to consider

biopsy during laryngoscopy
oropharyngeal cultures
nasal swab for culture
serum immunoprecipitation, polymerase chain reaction, or immunochromatography for diphtheria
CBC
rapid antigen detection test
CXR
sputum cultures
purified protein derivative skin test (PPD)
videostroboscopy

Full details

Treatment algorithm

INITIAL

Contributors

Authors VIEW ALL 

Chad W. Whited, MD

Clinical Faculty

Laryngeal surgeon and general otolaryngologist

Austin ENT Clinic

Austin

Texas

Disclosures

CWW declares that he has no competing interests.

Seth H. Dailey, MD

Chief

Section of Laryngology and Voice Surgery

Associate Professor

Division of Otolaryngology - Head and Neck Surgery

University of Wisconsin School of Medicine and Public Health

Madison

Disclosures

SHD declares that he has no competing interests.

Acknowledgements

Dr Chad W. Whited and Dr Seth H. Dailey would like to gratefully acknowledge Dr Ozlem E. Tulunay-Ugur, a previous contributor to this topic. OETU declares that she has no competing interests.

Peer reviewers VIEW ALL 

Michael Johns, MD

Director

Assistant Professor

Emory University

Atlanta

Disclosures

MJ declares that he has no competing interests.

James Suen, MD

Chair; Professor

University of Arkansas for Medical Sciences

Department of Otolaryngology - Head and Neck Surgery

Little Rock

Disclosures

JS declares that he has no competing interests.

Remco de Bree, MD, PhD

Otolaryngologist

Head and Neck Surgeon

VU University Medical Center

Amsterdam

The Netherlands

Disclosures

RdB declares that he has no competing interests.

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Laryngitis

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic investigations

1st investigations to order

Investigations to consider

Treatment algorithm

with potential airway compromise

viral

suspected bacterial: nondiphtheria and nontuberculous

confirmed diphtheria

tuberculosis

fungal

vocal strain

Contributors

Authors VIEW ALL 

Chad W. Whited, MD

Disclosures

Seth H. Dailey, MD

Disclosures

Acknowledgements

Peer reviewers VIEW ALL 

Michael Johns, MD

Disclosures

James Suen, MD

Disclosures

Remco de Bree, MD, PhD

Disclosures

Differentials

Guidelines

Patient leaflets

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