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).
Laryngitis is often clinically diagnosed, with acute disease presenting with hoarseness that generally arises over a period of <7 days, this is usually preceded by a viral upper respiratory infection, and is ordinarily self-limiting. Patients may present with airway distress due to edema and high fever. Exudative tonsillopharyngitis with fever and anterior cervical lymphadenitis is highly suggestive of a bacterial origin.
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 is the presence of laryngeal inflammatory symptoms including hoarseness, globus, pain, dysphagia, throat clearing, or cough lasting >3 weeks. A thorough evaluation and specialist consultation should be obtained to evaluate for inflammatory, infectious, or autoimmune etiologies, and because chronic laryngitis can mimic symptoms 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.
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
- sore throat
- hyperemia of the oropharynx
- history of heavy vocal use
- gastroesophageal reflux
- oropharyngeal white-gray exudates
Other diagnostic factors
- fatigue and malaise
- enlarged tonsils
- enlarged, tender anterior cervical lymph nodes
- postnasal drip
- weight loss
- tonsillopharyngeal exudate
- acute respiratory distress
- toxic appearance
- 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
1st investigations to order
Investigations to consider
- biopsy during laryngoscopy
- oropharyngeal cultures
- nasal swab for culture
- serum immunoprecipitation, polymerase chain reaction, or immunochromatography for diphtheria
- complete blood count
- rapid antigen detection test
- chest x-ray
- sputum cultures
- purified protein derivative skin test (PPD)
with potential airway compromise
suspected bacterial: nondiphtheria and nontuberculous
Chad W. Whited, MD
Laryngeal surgeon and general otolaryngologist
Austin ENT Clinic
CWW declares that he has no competing interests.
Seth H. Dailey, MD
Section of Laryngology and Voice Surgery
Division of Otolaryngology - Head and Neck Surgery
University of Wisconsin School of Medicine and Public Health
SHD declares that he has no competing interests.
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.
Michael Johns, MD
MJ declares that he has no competing interests.
James Suen, MD
University of Arkansas for Medical Sciences
Department of Otolaryngology - Head and Neck Surgery
JS declares that he has no competing interests.
Remco de Bree, MD, PhD
Head and Neck Surgeon
VU University Medical Center
RdB declares that he has no competing interests.
- Infectious mononucleosis
- Allergic rhinitis
- Clinical practice guideline: hoarseness (dysphonia)
- Sore throat (acute): antimicrobial prescribing
Sore throatMore Patient leaflets
- Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer