Acute Laryngitis

Updated: Jun 01, 2016

Author: Rahul K Shah, MD, FACS, FAAP; Chief Editor: Arlen D Meyers, MD, MBA

http://emedicine.medscape.com/article/864671-overview

Background
Laryngitis is one of the most common conditions identified in the larynx. Laryngitis, an
inflammation of the larynx, manifests in both acute and chronic forms.

Acute laryngitis has an abrupt onset and is usually self-limited. If a patient has symptoms of
laryngitis for more than 3 weeks, the condition is classified as chronic laryngitis. The etiology
of acute laryngitis includes vocal misuse, exposure to noxious agents, or infectious agents
leading to upper respiratory tract infections. The infectious agents are most often viral but
sometimes bacterial.

See the image below.

This view depicts the larynx of a 62-year-old woman with an intermittent history of exudative
acute laryngitis that was treated conservatively. Courtesy of Ann Kearney, Palo Alto, Calif.
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Rarely, laryngeal inflammation results from an autoimmune condition such as rheumatoid
arthritis, relapsing polychondritis, Wegener granulomatosis, or sarcoidosis. A case report
showed a 2-year-old intubated patient who was given activated charcoal for poisoning,
resulting in obstructive laryngitis. This unusual case demonstrates the myriad potential
etiologies of acute laryngitis.

Chronic laryngitis, as the name implies, involves a longer duration of symptoms; it also takes
longer to develop. Chronic laryngitis may be caused by environmental factors such as
inhalation of cigarette smoke or polluted air (eg, gaseous chemicals), irritation from asthma
inhalers, vocal misuse (eg, prolonged vocal use at abnormal loudness or pitch), or
gastrointestinal esophageal reflux. Vocal misuse results in an increased adducting force of the
vocal folds with subsequent increased contact and friction between the contacting folds. The
area of contact between the folds becomes swollen. Vocal therapy has the greatest benefit in
the patient with chronic laryngitis.

Although acute laryngitis is usually not a result of vocal abuse, vocal abuse is often a result of
acute laryngitis. The underlying infection or inflammation results in a hoarse voice. Typically,
the patient exacerbates the dysphonia by misuse of the voice in an attempt to maintain
premorbid phonating ability.

Pathophysiology

Acute laryngitis is an inflammation of the vocal fold mucosa and larynx that lasts less than 3
weeks. When the etiology of acute laryngitis is infectious, white blood cells remove
microorganisms during the healing process. The vocal folds then become more edematous,
and vibration is adversely affected. The phonation threshold pressure may increase to a
degree that generating adequate phonation pressures in a normal fashion becomes difficult,
thus eliciting hoarseness. Frank aphonia results when a patient cannot overcome the
phonation threshold pressure required to set the vocal folds in motion.

The membranous covering of the vocal folds is usually red and swollen. The lowered pitch in
laryngitic patients is a result of this irregular thickening along the entire length of the vocal
fold. Some authors believe that the vocal fold stiffens rather than thickens. Conservative
treatment measures, as outlined below, are usually enough to overcome the laryngeal
inflammation and to restore the vocal folds to their normal vibratory activity.