Laryngitis

1 What is Laryngitis?

Laryngitis is an inflammation of the voice box (larynx). Causes of laryngitis include upper respiratory infection or cold, overuse of the voice box by talking, singing, or shouting, gastroesophageal reflux disease (GERD), reflux laryngitis, chronic irritation of the vocal cords, smoking, exposure to secondhand smoke, or exposure to polluted air.

Laryngitis is contagious only if it is caused by an infection. The most common symptoms of laryngitis are hoarseness, loss of voice, and throat pain.

Symptoms of laryngitis in adults include dry, sore throat, pain with swallowing, and a feeling of fullness in the throat or neck. If the laryngitis is caused by an infection additional symptom of fever, swollen lymph nodes may be experienced.

Symptoms of laryngitis in infants in children include croup, hoarse barky cough, and fever. Chronic laryngitis, in which the symptoms last for weeks may be caused by gastroesophageal reflux, smoking, constant exposure to second-hand smoke, air pollution, or alcohol use.

Chronic inflammation due to laryngitis may cause the formation of nodules or polyps on the vocal cords. Treatment of laryngitis is usually symptomatic with voice rest, humidified air, and certain home remedies for symptom relief.

If symptoms of laryngitis persist for more than three weeks or continue to recur, contact your health care professional for further evaluation. Complications of laryngitis from GERD include pneumonia and chronic bronchitis.

2 Symptoms

Hoarseness, loss of voice, and throat pain are the primary symptoms of laryngitis. If the cause of laryngitis is infectious, affected individuals will have symptoms of a viral infection.

Symptoms of laryngitis in adults:

Symptoms of laryngitis in infants and children:

Air enters into our lungs like as follows, the ribs swing out, and the diaphragm (the muscle that separates the chest from the abdomen) pushes down, sucking air through the mouth and nose, past the larynx and into the trachea and lungs. 

In children with croup, breathing becomes difficult. As the child tries to inhale through a swollen and narrow larynx, the cartilage may collapse, just like when attempting to breathe through a straw.

As we age, the cartilage becomes stiffer and is able to withstand deeply indrawn breaths, but in children the cartilage is weaker and with each inspiration, the child may need to work hard to inhale. The maturing of laryngeal cartilage and widening of airways usually occurs by age 6 or 7.

In infants and young children, the classic signs and symptoms of an inflamed larynx caused by infection include:

Other symptoms of laryngitis: When the cause of laryngitis is not infectious, a cough may be a significant symptom along with the hoarseness.

There also can be a fullness felt in the throat. The patient also may complain of difficulty swallowing and have shortness of breath. Rarely, the patient can cough up blood-tinged saliva if the inflammation causes minor bleeding.

3 Causes

Laryngitis causes may vary depending on its type.

Laryngitis can be infectious as well as noninfectious in origin. Chronic laryngitis also may be caused by more severe problems, such as nerve damage, sores, polyps, or hard and thick lumps (nodules) on the vocal cords.

Noninfectious:

  • Acid reflux disease, resulting in laryngitis gastrica
  • Allergies
  • Excessive or chronic coughing, smoking, or alcohol consumption.
  • Inflammation due to overuse of the vocal cords
  • Prolonged use of inhaled corticosteroids for asthma treatment
  • Thermal or chemical burns
  • Laryngeal trauma, including iatrogenic one, caused by endotracheal intubation

Infectious:

  • Viral laryngitis can be caused by rhinovirus, influenza virus, parainfluenza virus, adenovirus, coxsackievirus, coronavirus, and RSV.
  • Bacterial laryngitis can be caused by group A streptococcus, streptococcus pneumoniae, C. diphtheriae, M. catarrhalis, haemophilusinfluenzae, bordetella pertussis, bacillus anthracis, and M. tuberculosis. Bacterial infections usually follow pre-existing viral infection.
  • Fungal laryngitis can be caused by Histoplasma, Blastomyces, Candida (especially in immunocompromised persons), and rarely by Cryptococcus and Coccidioides.

Laryngitis can occasionally lead to pneumonia, either viral pneumonia or bacterial pneumonia.

4 Making a Diagnosis

Laboratory Studies:

No laboratory studies are necessary. If the patient has an exudate in the oropharynx or overlying the vocal folds, a culture may be taken.

Do not institute antibiotic coverage until the results of the Gram stain and cultures with sensitivity have been determined.

Imaging Studies:

Direct fiber optic or indirect laryngoscopy may be performed to provide a view of the larynx. This examination reveals redness and small dilated vasculature on the inflamed vocal folds.

Analysis of vocal fold movement reveals asymmetry and aperiodicity with reduced mucosal waves and incomplete vibratory closure. The propagation of the mucosal wave is also reduced.

5 Treatment

Treatment methods of laryngitis vary depending on its cause.

  • Voice rest is important. Steam inhalations with tincture of benzoin or oil of pine or eucalyptus help loosen secretions. Cough suppressants are sometimes given to reduce a cough. For a severely inflamed larynx, a humidifier or vaporizer is used to moisten the air inhaled by a person.
  • If laryngitis is caused by gastroesophageal reflux, an H2-inhibitor (such as ranitidine) or proton-pump inhibitor (such as omeprazole) is used to reduce gastric acid secretions.
  • If laryngitis is caused by thermal or chemical burns, steroids are used.
  • In viral laryngitis, drinking sufficient fluids is helpful.
  • If laryngitis is due to a bacterial or fungal infection, appropriate antibiotic or antifungal therapy is given.
  • If persistent, hoarseness or loss of voice (dysphonia) is a result of vocal cord nodules. Physicians may recommend a course of treatment that may include a surgical procedure and/or speech therapy.

Antibiotics do not appear to be very useful

6 Prevention

As laryngitis is often caused by a common viral infection, such as a cold or flu, it's not always possible to prevent it.

Some ways to prevent it include:

  • Making sure you have the annual flu vaccine(if recommended by your GP)
  • Practicing good personal hygiene – such as washing your hands before and after eating and after using the toilet
  • Avoiding close contact with people who have respiratory infections, such as a cold or flu – particularly if you're prone to laryngitis
  • Avoiding irritants, such as smoke or dust – particularly if you have a cold or other respiratory infection.
  • Not smoking
  • Not drinking more than the recommended levels of alcohol consumption.
  • Not regularly clearing your throat – as this can irritate the larynx (try swallowing instead)
  • Raising your head with pillows when you're sleeping – to protect your larynx from any acid reflux from your stomach during sleep
  • Not shouting or singing loudly or for long periods of time – it's important for people who regularly use their voice excessively to receive proper training so they don't damage their larynx.

7 Alternative and Homeopathic Remedies

Several alternative remedies exist for laryngitis.

Apple Cider Vinegar: The acidic and antibacterial properties of apple cider vinegar help one get rid of the infection and swelling quickly and efficiently, thereby treat the condition permanently.

  • Mix ¼ cup of apple cider vinegar and 2 tablespoons of honey. Consume it multiple times a day. You can add ¼ cup of lukewarm water to it as well, as per your convenience.
  • Alternatively, dilute apple cider vinegar in 50% water and use it to gargle 4-5 times a day. It prevents the growth of bacteria and virus in the throat.

Salt Water Gargle: Some people believe that warm saline water is good for gargles during laryngitis.

  • To prepare, dissolve ½ teaspoon salt in a glass of lukewarm water.
  • Gargle at least 4-5 times a day. Salt has antibacterial properties.
  • Hence, this will kill bacteria and viruses, as well as ease the soreness and swelling.
  • While gargling, try to take the salt water as far back into your throat as possible, so that, it touches the larynx which is where the actual healing is required. Retain the water in your throat as long as you can and do not drink or eat anything for half an hour after gargling.
  • Gargle with turmeric or Listerine in lukewarm water.

Note - In some cases, salt, turmeric, and Listerine might be harmful. So, consult your doctor before gargling with any of these elements.

Turmeric: It relieves soreness and inflammation of the throat.

  • Add ½ teaspoon of turmeric in a glass of milk.
  • Consume it 2-3 times a day. 

Mouthwash: Mouthwash is good for you, as it helps you get rid of the bacteria and virus present in your mouth and throat, thus, alleviate laryngitis.

Honey: You can consume a spoonful of honey 4 times a day at regular intervals. It eases pain and inflammation in the throat. Since it has antibacterial properties, it eases the infection as well. It soothes and clears mucus blockages in the throat.

Cinnamon: Cinnamon has anti-inflammatory, antiseptic, and antibacterial properties which cure laryngitis quickly.

  • Add 1 teaspoon of cinnamon powder and 3 teaspoons of honey in boiling water for 10 minutes.
  • Consume this thrice a day for the best results. 

Clove: Clove provides the required warmth to the throat. It consists of antioxidants, anti-inflammatory, and antiseptic properties. It alleviates infection and, simultaneously, soothes the throat.

  • Blend four drops of clove oil and 1 teaspoon of honey properly.
  • Consume this thrice a day. 

Raisins:

  • Boil ¼ cup of raisins in 1 cup of water.
  • Consume this mixture 3-4 times a day.

Lemon Juice or Lemon Tea: Lemon juice and lemon tea are also beneficial for the larynx. A combination of honey, a few drops of lemon juice and lukewarm water will help you get rid of the bacteria and viruses.

  • Lemon juice can also be used to gargle. Mix a few drops of lemon juice in lukewarm water. Dissolve a pinch of salt in it.
  • Mix ¼ teaspoon of cayenne pepper in a glass of lemon juice. Consume it 3-4 times a day.

Note – Some people consider that lemon has acidic properties which make it good to fight against bacterial infections and germs. It also increases the amount of saliva produced in the mouth which, in turn, ensures that throat is hydrated. But some people dissuade from consuming any kind of sour thing including lemon when you are suffering from laryngitis or a sore throat. So, you can ask your physician or healthcare professional before trying any remedy associated to lemon.

Green Tea: Green tea is another excellent remedy to alleviate the symptoms of laryngitis.

Chamomile, Sage, and Peppermint Tea:

  • Boil a handful of chamomile/sage/peppermint leaves in water for 15-20 minutes.
  • Choose one herb at a time.
  • You can make 3 kinds of teas by following the same method.
  • You can also use chamomile and sage tea for gargling.

Soups: If you love having soups, then this is the best time to have them as much as you can. Refrain from excessive sodium containing soups.

Mixed Juice: Combine orange, cranberry, and grapefruit juice, and consume it on a daily basis. A mix of carrot, radish and ginger juice is also equally effective.

Garlic: Suck the juice of garlic by placing a piece or two in your mouth. You can crush it with your teeth and gulp it down. Do this 3-4 times a day for quick recovery. Since it has anti-microbial properties, it kills bacteria and viruses which are the root causes of such infections.

  • Mix crushed garlic cloves and honey to form a paste.
  • Consume 1 teaspoon of this paste with a glass of water 3-4 times a day.
  • Finely chop four cloves of garlic.
  • Heat one teaspoon of ghee and cook the chopped garlic in it for a minute. Add a pinch of salt and consume this mixture twice a day.

Note: Some physicians do not suggest the use of ghee and oil in laryngitis. So, we suggest you confirm from your doctor before trying the latter method of using garlic. Some people believe that garlic can be harmful in laryngitis, so we suggest you confirm from your physician about consumption of garlic regarding your particular case.

Ginger: Ginger also has anti-microbial properties and helps you get rid of viral and bacterial infections. It also soothes larynx and throat, consequently alleviates pain and inflammation.

  • Boil 2 teaspoons of grated ginger in 2 cups of water. Boil down the water till it reduces to 50%. Filter the resultant solution and add two teaspoons of honey to it.
  • Boil small pieces of ginger root in water for 20-30 minutes. Filter it. You can add lemon and honey to it. Let it cool and consume it multiple times in a day.
  • Sucking small pieces of ginger would also help. Chew it a little before gulping, as the juice will relieve the soreness and inflammation in the throat.
  • You can add ginger to your tea as well.

Anise Seeds:

  • Boil 2 teaspoons of anise seeds in 2 cups of water.
  • Ingest this fluid multiple times a day, but not more than 2 teaspoons in an hour.
  • You can also choose to apply this fluid on your neck and chest.

Onion Syrup: To avoid buying readymade cough syrup from the market, you can make one at home.

  • Finely chop a couple of onions.
  • Boil these small pieces of onions in 5 cups of water till it becomes consistently thick.
  • In a glass of lukewarm water, add 2-4 tablespoons of this syrup, one tablespoon honey, and a few drops of lemon juice.
  • Consume this twice a day.

Marshmallow: Eating marshmallow helps relieve a sore throat. You can also suck its juice to get relief from laryngitis. Alternatively, prepare herbal tea using marshmallow root.

Licorice Root:

  • Chop licorice sticks into small pieces and then put them in the boiling water. You can use this water for gargling after it becomes lukewarm.
  • Prepare tea using this root and consume 2-3 times a day.
  • Suck a licorice stick to lessen your craving to smoke. It has anti-inflammatory properties. Hence, it cures laryngitis as well.

Note – Patients with high blood pressure, heart diseases, kidney diseases, liver diseases, pregnant or breastfeeding women, and people who take blood-thinners like aspirin, warfarin (Coumadin) should not intake licorice in any form.

Eucalyptus: Eucalyptus is very commonly used for curing symptoms of cold and cough. It also helps relieve and soothe soreness and irritation in the throat. It can be found in many cough syrups, lozenges, and vapor baths. Use fresh eucalyptus leaves for preparing tea.

Note – Do not consume eucalyptus oil orally, it can be poisonous for internal use.

Mullein, Licorice, Slippery Elm: These three herbs can be used to prepare tea. They help moisten your throat as well as relieve irritation.

Herbal Infusion:

  • Get 1 teaspoon licorice root.
  • 1 teaspoon mullein leaves.
  • 1 teaspoon coltsfoot leaves.
  • 1 tablespoon marshmallow leaves, and 1 cup water.
  • Mix these herbs and then steep in boiling water for 20-30 minutes. If you find it too bitter to consume, sweeten it as per your requirement, by adding sugar or honey.

Couch Grass: Couch grass is famous for the treatment of kidney stones and urination. It is used to cure bronchitis as well. It is not so popular for the treatment of laryngitis because it does not relieve vocal strain caused by screaming or yelling. But it can be used to make phlegm softer so that one could expectorate easily.

  • Couch grass can be used in the form of a tea.
  • Boil some grass in the water. After the solution becomes lukewarm, use it to gargle.

Steam Inhalation: Steaming soothes your throat as well as respiratory tract.

  • Boil some water in a pot for 15-20 minutes.
  • Place the pot on a protected flat surface. Cover your head with a towel.
  • Lean forward over the pot and breathe in and out the steam for 15-30 minutes.
  • Breathe through your mouth as well nose because it will clear the blockages of throat and nose.
  • Maintain proper distance between your face and the pot.
  • Repeat it every day until you get relief. 
  • To enhance the effect of steaming, you can add a few drops of eucalyptus oil, fresh mint leaves, or freshly ground cloves.
  • Hot water bath also gives you the required warmth.

Aloe Vera:

  • Mix 2 teaspoons of fresh aloe vera gel with 2 teaspoons of honey.
  • Consume this once a day.
  • You can also gargle with aloe vera juice 2-3 times a day by diluting it in saline water.

8 Lifestyle and Coping

Lifestyle modifications are necessary in order to cope with laryngitis.

Do’s

  • Speak as little as possible to provide maximum rest to your throat. Do not whisper at all. Extra deep slumber will help you recover soon.
  • Drink 8-12 glasses of water to make sure that your larynx remains hydrated.
  • Consume a variety of liquids as much as possible like fresh fruit/vegetable juices and herbal teas.
  • Quit alcohol and caffeinated drinks because they dehydrate your throat.
  • Breathe humidified/moist air. If you do not have a humidifier or vaporizer, you can hang wet towels all around your room which will, eventually, make the dry air humid.
  • Use throat sprays or you can suck lozenges.
  • Ensure that you breathe through the nose because breathing through your mouth will expose your larynx to cold air.
  • Quit smoking. Specifically, tobacco smoke, marijuana smoke, and cocaine are very harmful to vocal cords and larynx. Save yourself from passive smoking as well.
  • Laryngitis spreads through viral infection. You can easily catch it by touching the contaminated surfaces. Wash your hands using lukewarm water and soap frequently. Develop a habit of cleaning common surfaces in your house where there is a probability of piling up of germs, such as the telephone and door handles, using vinegar and a hygienic cloth.

Don’ts

  • Do not consume any fluid when it is too hot/cold.
  • Do not attempt to clear your throat forcefully, as it will enhance the irritation. And try not to cough very frequently.
  • Do not access dry, smoky or dusty areas.
  • Don’t consume oily, spicy, and acidic foods like peppers, fried fish, onion, garlic, tomatoes.
  • Avoid having heavy meals. Do not have your dinner just before bedtime. Maintain a gap of 3-4 hours between your dinner and sleeping time. Do not eat anything else after dinner.
  • Do not eat chocolates and ice-cream.

9 Risks and Complications

There are several risks and complications associated with laryngitis.

If the cause of laryngitis is vocal cord paralysis, the swallowing mechanism may also be affected, and food particles may enter the larynx and lungs, leading to coughing. This process can also lead to aspiration pneumonia and its accompanying symptoms (fever, cough, shortness of breath) when the food is aspirated deep into the lungs and causes irritation and inflammation of lung tissue.

Repeated episodes of gastroesophageal reflux may cause small amounts of acid to get past the inflamed larynx and enter the lung, causing recurrent pneumonia or bronchitis.

Prior to the advent of Haemophilus influenza immunization, epiglottitis due to H. flu was always considered as a possible alternative diagnosis in children with croup. This was a life-threatening medical emergency because the epiglottis could massively swell, blocking air from entering the larynx and lungs. X-rays of the neck were taken to visualize the epiglottis and look for swelling.

The diagnosis was often confirmed in the operating room where the otolaryngologist and anesthesiologist would use laryngoscopy to look at the epiglottis and vocal cords and decide whether to insert a breathing tube in the child's airway to prevent the airway from swelling shut. Fortunately, because of immunization, this disease is rarely seen.

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