Laryngitis: Causes, Symptoms, and Treatment of Acute Laryngitis

Inflammation of the larynx is also known as laryngitis. Doctors primarily distinguish between acute and chronic laryngitis.

Acute Laryngitis

This condition of the larynx is usually a viral infection of the vocal cords.

Clinical symptoms are similar to those of a cold: hoarseness with a coughing sensation, a sore throat, and a dry feeling in the throat.

To treat the infection, patients should use inhalers; in severe cases, sprays may also be used. This helps alleviate the symptoms. In addition, those affected should rest their vocal cords and avoid smoking.

Those affected instinctively resort to whispering, but this places additional strain on the voice, especially in cases of laryngitis.

If the infection is bacterial, treatment for laryngitis should also include antibiotics. Cefuroxime is typically prescribed; clindamycin may be used if the patient has an allergy.

Laryngitis usually clears up within 7–10 days and, depending on the cause, may also be contagious. 

Chronic laryngitis

Chronic inflammation of the larynx can result from a viral infection caused by excessively dry air (air conditioning) or irritants (dust, cigarette smoke, and other pollutants). The vocal cords, in particular, are sensitive to these factors and are prone to inflammation.

The condition is also referred to as chronic laryngitis when the symptoms of laryngitis persist for more than three weeks. This should definitely be evaluated by a doctor.

In people who breathe heavily through their mouths (due to impaired nasal breathing), humidity levels are also insufficient. This can lead to chronic laryngitis.

The symptoms are similar to those of acute laryngitis:

• Feeling of a lump in the throat
• Hoarseness & loss of voice
• Coughing and
• frequent throat-clearing & an urge to clear the throat

The following treatment is recommended:

• Avoiding irritants
• restoring nasal breathing on a long-term basis, if necessary, as well as
• short-term voice rest combined with inhalation therapy

Other forms of laryngitis

Pseudocroup (acute subglottic laryngitis): Pseudocroup is also primarily a viral illness. If a bacterial infection also develops, doctors refer to this as a superinfection.

In this condition, which occurs in childhood, the mucous membrane below the glottis swells. The child suffers from flu-like symptoms, a barking cough, and narrowed airways, which are noticeable through distinctly audible breathing sounds.

Decongestant inhalations are important, as is antibiotic therapy with cefuroxime (or clindamycin in cases of allergy). In rare cases, intubation may be necessary (emergency situation). It is recommended to avoid excessive strain on the voice and to keep the mucous membranes moist. 

Tuberculous laryngitis: An infection with M. tuberculosis can lead to monochorditis in the larynx. It is characterized by granulomatous changes (granule-like tissue growths).

The symptoms correspond to those of the other chronic laryngeal conditions listed. Diagnosis is made via a biopsy (tissue sample). Treatment involves a tuberculostatic regimen (triple therapy).

Posterior laryngitis: This form develops as a result of reflux disease, in which stomach acid repeatedly enters the esophagus. The stomach acid damages the mucous membranes of the larynx, particularly in the area of the arytenoid cartilages and the interarytenoid region.

Symptoms include hoarseness and a cough reflex, as well as inflammation of the laryngeal mucosa, accompanied by redness and swelling.

Treatment involves reducing or preventing reflux through:

• dietary changes and
• medication with anti-reflux therapy (proton pump inhibitors)

Laryngeal papillomatosis often occurs as early as childhood. It is caused by human papillomaviruses (HPV 6/11/16/18). The result is papillomatosis on the vocal folds. Papillomatosis refers to warts caused by viruses.

In children, these often appear in multiple areas of the body, while in adults they often appear in only one area.

To treat the condition, doctors remove the papillomas using a laser. Laser ablation requires a two-day hospital stay. In addition, doctors can inject medications that activate the immune system so that it fights off the pathogens on its own.

The main problem with this condition is its tendency to recur and to spread downward.

This laryngeal disorder is a mostly congenital pathological softening of the larynx. When the structures are too soft, a suction effect occurs during inhalation, preventing sufficient airflow.

Patients with laryngomalacia exhibit characteristic breathing sounds during exhalation. These symptoms may be congenital.

In the first few years of life, the symptoms often improve on their own. Therefore, surgical intervention is rarely necessary. In addition to laser treatment, a temporary tracheotomy (incision in the windpipe) may be considered if necessary.

Laryngoceles are hernia-like protrusions in the area of the larynx. Depending on their location, physicians distinguish between internal and external laryngoceles.

Common symptoms include:

• a sensation of a lump in the throat
• difficulty swallowing (dysphagia) or
• breathing difficulties (dyspnea)

Treatment is surgical, usually performed endoscopically using a laser. In rare cases, open surgery from the outside is required.

Laryngeal cancer is the most common type of cancer in the neck region. Men are affected about ten times more often than women. Smoking and alcohol abuse are considered the most common causes of malignant tumors of the larynx.

Laryngeal cancer is a squamous cell carcinoma, which is a form of skin cancer. 

Depending on the location, doctors distinguish between four forms:

1. Vocal cords – glottic carcinoma: The tumor is located in the area of the vocal cords and the posterior wall of the larynx
2. Below the vocal cords – subglottic laryngeal carcinoma: The tumor is located below the vocal cords
3. Epiglottis – supraglottic laryngeal carcinoma: The tumor is located in the area of the epiglottis
4. Entire larynx – Transglottic laryngeal carcinoma: The tumor extends across the entire larynx

Treatment generally involves surgical removal of the tumor (tumor resection). Both laser-endoscopic and open-surgery procedures are available for this purpose.

For larger tumors, postoperative radiation therapy should be administered. If the tumor is inoperable or if the patient has severe comorbidities, combined chemoradiotherapy is also an option. Antibody therapy may also be used in some cases.

Swallowed fish bones and other foreign bodies rarely cause problems when they become lodged in the larynx. However, if complications do arise, removal of the swallowed object is necessary.

In most cases, blunt trauma to the larynx occurs, such as that caused by a car accident or a motorcycle helmet. Sharp trauma, such as that caused by a knife, is rare.

Laryngeal fractures—and even tracheal lacerations—can lead to the following symptoms due to obstruction or bleeding:

• Shortness of breath
• Difficulty swallowing, and
• Voice changes

The primary priority is to secure the airway through surgical reconstruction. The intubation procedure performed under general anesthesia can lead to dislocation (injury) of one or both arytenoid cartilages.

If intubation is prolonged, intubation granulomas may form. Patients who are intubated for long periods often develop subglottic tracheal stenosis or tracheomalacia in the area of the cuff.

A temporary tracheotomy must be performed in a timely manner to prevent these complications.

Reinke’s edema is a fluid accumulation in the Reinke’s space of the vocal folds. It is caused by vocal strain and/or smoking, including secondhand smoke. This results in a hoarse voice and, occasionally, a cough reflex.

As a first step in treatment, the patient should improve their vocal hygiene and avoid irritants. Vocal hygiene refers to lifestyle adjustments made to preserve and protect the voice.

If this does not lead to improvement, phonosurgical ablation may be performed. The ablation is performed under general anesthesia as part of a microlaryngoscopy.

Possible complications include permanent hoarseness and recurrent edema after surgery.