laryngitis

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Laryngitis

 

Definition

Laryngitis is caused by inflammation of the larynx, resulting in hoarseness of the voice.

Description

When air is breathed in (inspired), it passes through the nose and the nasopharynx or through the mouth and the oropharynx. These are both connected to the larynx, a tube made of cartilage. The vocal cords, responsible for setting up the vibrations necessary for speech, are located within the larynx. The air continues down the larynx to the trachea. The trachea then splits into two branches, the left and right bronchi (bronchial tubes). These bronchi branch into smaller air tubes which run within the lungs, leading to the small air sacs of the lungs (alveoli).
Either food, liquid, or air may be taken in through the mouth. While air goes into the larynx and the respiratory system, food and liquid are directed into the tube leading to the stomach, the esophagus. Because food or liquid in the bronchial tubes or lungs could cause a blockage or lead to an infection, the airway must be protected. The epiglottis is a leaf-like piece of cartilage extending upwards from the larynx. The epiglottis can close down over the larynx when someone is eating or drinking, preventing these substances from entering the airway.
In laryngitis, the tissues below the level of the epiglottis are swollen and inflamed. This causes swelling around the area of the vocal cords, so that they cannot vibrate normally. A hoarse sound to the voice is very characteristic of laryngitis. Laryngitis is a very common problem, and often occurs during the course of an upper respiratory tract infection (cold).

Causes and symptoms

Laryngitis is caused almost 100% of the time by a virus. The same viruses which cause the majority of simple upper respiratory infections (colds, etc.) are responsible for laryngitis. These include parainfluenzae virus, influenza virus, respiratory syncytial virus, rhinovirus, coronavirus, and echovirus. Extremely rarely, bacteria such as Group A streptococcus, M. catarrhalis, or that which causes tuberculosis may cause laryngitis. In people with faulty immune systems (particular due to acquired immunodeficiency syndrome, or AIDS), infections with fungi may be responsible for laryngitis.
Symptoms usually begin along with, or following, symptoms of a cold. A sore, scratchy throat, fever, runny nose, achiness, and fatigue may all occur. Difficulty swallowing sometimes occurs with streptococcal infections. The patient may cough and wheeze. Most characteristically, the patient's voice will sound strained, hoarse, and raspy.
In extremely rare cases, the swelling of the larynx may cause symptoms of airway obstruction. This is more common in infants, because the diameter of their airways is so small. In that case, the baby may have a greatly increased respiratory rate, and exhibit loud high-pitched sounds with breathing (called stridor).

Diagnosis

Diagnosis is usually made by learning the history of a cold followed by hoarseness. The throat usually appears red and somewhat swollen. Listening to the chest and back with a stethoscope may reveal some harsh wheezing sounds with inspiration (breathing in).
In long-standing (chronic laryngitis), tuberculosis may be suspected. Using a scope called a laryngoscope, examination of the airway will show redness, swelling, small bumps of tissue called nodules, and irritated pits in the tissue called ulcerations. Special skin testing (TB testing) will reveal that the individual has been exposed to the bacteria causing TB.

Treatment

Treatment of a simple, viral laryngitis simply addresses the symptoms. Gargling with warm salt water, pain relievers such as acetaminophen, the use of vaporizers to create moist air, and rest will help the illness resolve within a week.
In an infant who is clearly struggling for air, it may be necessary to put in an artificial airway for a short period of time. This is very rarely needed.
An individual with tubercular laryngitis is treated with a combination of medications used to treat classic TB. In people with fungal laryngitis, a variety of antifungal medications are available.

Alternative treatment

Alternative treatments include aromatherapy inhalations made with benzoin, lavender, frankincense, thyme, and sandalwood. Decoctions (extracts made by boiling an herb in water) or infusions (extracts made by steeping an herb in boiling water) can be made with red sage (Salvia officinalis var. rubra) and yarrow (Achillea millefolium) or with licorice (Glycyrrhiza glabra). These are used for gargling, and are said to reduce pain. Echinacea (Echinacea spp.) tincture taken in water every hour for 48 hours is recommended to boost the immune system. Antiviral herbs, including usnea (Usnea spp.), lomatium (Lomatium dissectum), and ligusticum (Ligusticum porteri), may help hasten recovery from laryngitis. Homeopathic remedies are recommended based on the patient's symptoms. Some people may get relief from placing cold compresses on the throat.

Prognosis

Prognosis for laryngitis is excellent. Recovery is complete, and usually occurs within a week's time.

Prevention

Prevention of laryngitis is the same as for any upper respiratory infections. The only way to even attempt to prevent such illnesses is by good handwashing, and by avoiding situations where one might come in contact with people who might be sick. However, even with relatively good hygiene practices, most people will get about five to six colds per year. It is unpredictable which of these may lead to laryngitis.

Resources

Organizations

American Academy of Otolaryngology-Head and Neck Surgery, Inc. One Prince St., Alexandria VA 22314-3357. (703) 836-4444. http://www.entnet.org.

Key terms

Epiglottis — A leaf-like piece of cartilage extending upwards from the larynx, which can close like a lid over the trachea to prevent the airway from receiving any food or liquid being swallowed.
Larynx — The part of the airway lying between the pharynx and the trachea.
Nasopharynx — The part of the airway into which the nose leads.
Oropharynx — The part of the airway into which the mouth leads.
Trachea — The part of the airway which leads into the bronchial tubes.

laryngitis

 [lar″in-ji´tis]
inflammation of the mucous membrane of the larynx, characterized by dryness and soreness of the throat, hoarseness, cough, and dysphagia.
Acute Laryngitis. Acute laryngitis may be caused by overuse of the voice, allergies, irritating dust or smoke, hot or corrosive liquids, or even violent weeping. It also occurs in viral or bacterial infections, and is frequently associated with other diseases of the respiratory tract. In adults, a mild case begins with a dry, tickling sensation in the larynx, followed quickly by partial or complete loss of the voice. There may be a slight fever, minor discomfort, and poor appetite, with recovery after a few days. Other more uncomfortable symptoms can include a feeling of heat and pain in the throat, difficulty in swallowing, and dry cough followed by expectoration; the voice may be either painful to use or absent. Swelling of the larynx and epiglottis may impair breathing. Increasing difficulty in breathing may be a sign of edematous laryngitis, or croup.

Treatment requires that the patient refrain from talking. The room temperature should be steady and warm. The air is kept moist with a humidifier or vaporizer. An ice bag on the throat often is soothing. In some cases, antibiotics may be necessary.

Children are especially vulnerable to laryngitis because of the smallness of their air passages. Most cases in children subside within a few days, but if inflammation and swelling continue to increase, severe dyspnea occurs.
Chronic Laryngitis. After repeated attacks of the acute type, chronic laryngitis may develop. This is caused mostly by continual irritation from overuse of the voice, tobacco smoke, dust, or chemical vapors, or by a chronic nasal or sinus disorder. Often the moist mucous membrane lining the larynx becomes granulated. The granulation can proceed to thickening and hardening of the mucous membrane, which changes the voice or makes it hoarse. There is little or no pain, though there may be tickling in the throat and a slight cough. Chronic laryngitis that has persisted for a number of years may result in chronic hypertrophic laryngitis, a condition in which there is a permanent change in the voice because of hypertrophy of the membrane lining the larynx.

Treatment for chronic laryngitis is the same as for the acute form, with elimination of all sources of irritation and reinfection. Hoarseness that lasts longer than 2 weeks may be a warning of tumor or cancer of the larynx, or of a tumor in the thorax that presses on the recurrent laryngeal nerve, which controls the larynx.
Other Forms of Laryngitis. Paroxysmal laryngitis is a nervous disorder affecting infants that seems to be associated with enlarged adenoids and rickets. It consists of unexplained spasms in which the larynx closes, cutting off the air passage, and then suddenly opens. Sometimes the condition may be fatal. Treatment of this form of laryngitis calls for removal of adenoids.

Other types include diphtheritic laryngitis, tuberculous laryngitis, traumatic laryngitis, and allergic laryngitis. Treatment of diphtheritic and traumatic laryngitis often involves intubation or tracheostomy in order to admit air. Allergic laryngitis, often caused by smoking or other irritants, is treated in the same way as other allergies.

lar·yn·gi·tis

(lar'in-jī'tis),
Inflammation of the mucous membrane of the larynx.
[laryngo- + G. -itis, inflammation]

laryngitis

/lar·yn·gi·tis/ (-ji´tis) inflammation of the larynx.laryngit´ic
subglottic laryngitis  inflammation of the undersurface of the vocal cords.

laryngitis

(lăr′ĭn-jī′tĭs)
n.
Inflammation of the larynx.

lar′yn·git′ic (-jĭt′ĭk) adj.

laryngitis

[ler′injī′tis]
Etymology: Gk, larynx + itis
inflammation of the mucous membrane lining the larynx, accompanied by edema of the vocal cords with hoarseness or loss of voice, occurring as an acute disorder caused by a cold, irritating fumes, or sudden temperature changes or as a chronic condition resulting from excessive use of the voice, heavy smoking, or exposure to irritating fumes. In acute laryngitis there may be a cough, and the throat usually feels scratchy and painful. The patient is advised to remain in an environment with an even temperature, to avoid talking and exposure to tobacco smoke, and to inhale steam containing aromatic vapors such as tincture of benzoin, oil of pine, or menthol. Acute laryngitis may cause severe respiratory distress in children under 5 years of age because the relatively small larynx of the young child is subject to spasm when irritated or infected and readily becomes partially or totally obstructed. The youngster may develop a hoarse, barking cough and an inspiratory stridor and may become restless, gasping for air. Treatment consists of the administration of copious amounts of vaporized cool mist. Chronic laryngitis may be treated by removal of irritants, avoidance of smoking, voice rest, correction of stressful voice habits, cough medication, steam inhalations, and spraying the throat with an astringent antiseptic, such as hexylresorcinol.

laryngitis

ENT Inflammation of the larynx, resulting in a hoarse voice and/or complete voice loss 2º to vocal cord irritations. See Reflux laryngitis.

la·ryn·gi·tis

(lar'in-jī'tis)
Inflammation of the mucous membrane of the larynx; accompanied by edema of the vocal cords, which produces hoarseness.
[laryngo- + G. -itis, inflammation]

laryngitis

Inflammation of the voice-box (LARYNX), usually as part of a common cold or other upper respiratory tract infection (URTI), but sometimes as a result of overuse of the voice. There is hoarseness, pain and difficulty in speaking. In most cases full recovery may be expected in a few days, especially if the voice is rested. See also CLERGYMAN'S THROAT and SINGERS' NODES.

la·ryn·gi·tis

(lar'in-jī'tis)
Inflammation of the mucous membrane of the larynx; accompanied by edema of the vocal cords, which produces hoarseness.
[laryngo- + G. -itis, inflammation]

laryngitis

(lar´injī´tis),
n an inflammation of the mucous membrane lining the larynx, accompanied by edema of the vocal cords with hoarseness (loss of voice).

laryngitis

inflammation of the mucous membrane of the larynx, characterized by cough, pain on palpation over the larynx, dysphagia, and possibly regurgitation through the nose; usually there are other signs of inflammation of the upper respiratory tract.

necrotic laryngitis
see calf diphtheria.