Acute laryngitis

Acute laryngitis (1)

• usually caused by
• infection
  • viral
    • is the most common cause of acute laryngitis
    • most often due to rhinovirus, adenovirus, influenza, and parainfluenza.
  • bacterial
    • difficult to differentiate from viral causes,
    • both viral and bacterial infections may co-exist - viral illness allowing opportunistic bacterial superinfection
    • common organisms - Haemophilus influenza B (HiB), Streptococcus pneumonia, Staphylococcus aureus, Moraxella catarrhalis
  • fungal
    • accounts for around 10% of presentations
    • recent use of antibiotics and use of inhaled corticosteroids are considered as risk factors
    • laryngeal examination may reveal - whitish speckling of the supraglottis or glottis, diffuse laryngeal erythema and oedema (may occur without these plaques)
    • candidiasis should be differentiated from other conditions such as hyperkeratosis, leucoplakia, and malignancy,
• trauma (2)
  • caused by excessive voice use or misuse during phonation e.g - yelling, screaming, forceful singing
  • other methods such as blunt or penetrating trauma, chronic coughing, or habitual throat clearing may also be responsible

It is more common in the winter months. The condition is usually preceded by an initial infective insult, for example, a common cold or influenza

• any area within the larynx maybe involved - supraglottis (epiglottis, arytenoids, and false vocal folds), the glottis (true vocal folds), and subglottic regions
• in a child, this condition may cause sufficient subglottic oedema to cause airway obstruction (3)

Predisposing factors include: (2)

• over-use of the voice
• smoking
• drinking spirits

Treatment of acute infectious laryngitis varies depending on the severity of the illness. Most doctors view viral laryngitis as a typically self-limiting illness, requiring supportive treatment alone. (1)

Vocal hygiene is key to effective supportive treatment. This includes voice rest, increased hydration, humidification, and limited caffeine intake. (1) The duration of voice rest is usually between 3 days and 2 weeks (4)

Antibiotics should only be indicated when a bacterial infection is suspected, and are usually started empirically (5)

Evidence in the literature for corticosteroid use for acute laryngitis is incomplete (6)

References:

1. Wood JM, Athanasiadis T, Allen J. Laryngitis. BMJ. 2014;349:g5827
2. Dworkin JP. Laryngitis: types, causes, and treatments. Otolaryngol Clin North Am. 2008 Apr;41(2):419-36.
3. Tristram D. Laryngitis, Tracheitis, Epiglottitis, and Bronchiolitis: Sore Throat, Change in Voice, Fever or a Wheezing Infant in Respiratory Distress. Introduction to Clinical Infectious Diseases. 2018 Oct 15:75–85.
4. Haben CM. Voice rest and phonotrauma in singers. Med Probl Perform Art. 2012 Sep;27(3):165-8.
5. Reveiz L, Cardona AF. Antibiotics for acute laryngitis in adults. Cochrane Database Syst Rev. 2015;(5):CD004783
6. Rafii B, Sridharan S, Taliercio S, et al. Glucocorticoids in laryngology: a review. Laryngoscope. 2014 Jul;124(7):1668-73.