Laryngitis Diagnosis

  • Diagnosis

    Laryngitis is inflammation of the vocal cords that results in a hoarse, raspy voice Figure 01. The vocal cords produce sound by vibrating. When they swell, the nature of the sound they produce changes. Mild inflammation usually results in mild hoarseness. As the inflammation worsens, the voice may be reduced to a harsh whisper.

    Click to enlarge: Normal Vocal Cords

    Figure 01. Normal Vocal Cords

    Laryngitis may be acute or chronic. In the acute form, the inflammation usually subsides without treatment after a few days to a week. In the chronic form, the inflammation persists indefinitely and may require treatment by an otolaryngologist (ear, nose, and throat specialist). Severe inflammation may be accompanied by pain, difficulty swallowing, and difficulty breathing.

    Acute laryngitis is usually caused by an upper respiratory tract infection. The infection may be localized to the larynx (voice box), or it may be part of a wider respiratory tract infection such as a cold or flu. Most cases of laryngitis are caused by viral infections, but bacterial infections such as bronchitis and pneumonia can also result in inflammation of the vocal cords.

    Overuse of the voice can lead to laryngitis. Shouting or screaming can obviously cause hoarseness, but even more subtle overuse can result in laryngitis as well. Examples include working in loud-noise environments where you have to talk loudly to be heard, or living with someone with hearing loss. Laryngitis related to abuse of the voice may be acute (e.g., as a result of yelling at a football game) or chronic (e.g., as in overuse of the voice by professional singers).

    Acid reflux, also known as gastroesophageal reflux disease, can cause chronic laryngitis. Regurgitation of stomach acid can cause irritation of the lining of the esophagus, larynx, and throat. Typically, acid reflux causes heartburn or an acid taste in the mouth, but many people with the condition have few symptoms other than a feeling of a “lump in the throat.” Left untreated, acid reflux can lead to chronic laryngitis, chronic sore throat, chronic coughing, and other problems.

    Persistent laryngitis in the absence of an infection or other cause could be a sign of cancer. Local throat irritation and hoarseness are the first signs of laryngeal cancer, a condition associated with smoking and heavy alcohol consumption. This cancer often affects the vocal cords by damaging the nerve that causes them to move. Laryngeal cancer primarily strikes men between the ages of 50 and 65. Women are much less likely than men to contract laryngeal cancer.

    The most common symptoms of laryngitis are hoarseness and loss of voice Table 01. Other symptoms include a raw throat, a dry cough, a tickling sensation in the back of the throat, and a constant need to clear the throat. The severity of inflammation determines the severity of symptoms. In more severe cases, symptoms may include pain, fever, difficulty swallowing, and general malaise. Severe swelling of the vocal cords may cause difficulty breathing. In chronic laryngitis, persistent hoarseness may be the only symptom.

    Table 1.  Symptoms of Laryngitis

    Common Symptoms
    Hoarseness or loss of voice
    Raw throat
    Dry cough
    Tickling sensation in the throat
    Persistent need to clear the throat
    Symptoms of severe inflammation
    Pain
    Fever
    Difficulty swallowing
    Difficulty breathing
    General malaise

    Persistent exposure to smoke or other irritants may result in chronic laryngitis. Constant exposure to smoke, dust, or other chemical irritants may cause chronic inflammation of the vocal cords. Heavy alcohol consumption can similarly irritate the linings of the mouth, throat, larynx, and esophagus. Chronic inflammation of the vocal cords can cause them to thicken, changing the nature of the voice, and increasing a person's risk of other complications.

    Laryngitis is an occupational hazard in some professions in which the voice is used extensively, including teaching, singing, or public speaking. If you have an occupation that requires heavy use of your voice, you are at risk of developing laryngitis. Even if you don't yell during the day, excessive or strenuous talking of the sort required in teaching, or working with hearing-impaired individuals, can lead to laryngitis over time.

    To determine the cause of your symptoms, your doctor will start with a medical history.If you have acute laryngitis, and you also have cold symptoms, most likely your doctor will attribute your symptoms to an upper respiratory tract infection. Chronic laryngitis may involve referral to a specialist. When you first seek treatment for severe or chronic laryngitis, your doctor will take a medical history to identify the most likely underlying cause. The history will include questions about recent respiratory tract infections, smoking, alcohol consumption, use of your voice, possible exposure to dust or environmental contaminants, and potential symptoms of acid reflux disease. Your answers to these questions will help your physician determine the most probable cause and appropriate course of treatment for your illness.

    During the examination, your doctor will observe the condition of your throat and vocal cords. When you open your mouth and say, “aaaa,” your doctor will be able to examine the back of your mouth, your tonsils, and throat for any signs of infection or disease. Using an angled mirror or a fiberoptic instrument called a nasopharyngoscope, your doctor will examine the condition of your vocal cords, looking for redness, swelling, lesions, or other signs of irritation, if you have chronic laryngitis.

    During the physical examination, your doctor will also look for symptoms of acid reflux. When acid reflux is suspected, your doctor may order a set of sophisticated tests to better characterize the condition, or may prescribe drugs or lifestyle changes to treat the reflux to see empirically whether the laryngitis improves.

    Vocal cord nodules, polyps, and contact ulcers can also cause hoarseness or loss of voice. Because these lesions are not generally associated with inflammation, they are not considered to be a sign of laryngitis, even though they have similar causes and treatment.

    If a bacterial infection is suspected for recent onset of laryngitis, your doctor may take a throat culture. Bacterial infections such as bronchitis, pneumonia, and diphtheria can cause laryngitis. Because the most effective treatment for each of these infections requires specific antibiotics, your doctor may take a throat swab and send it to a laboratory for identification. Most likely, your doctor will make an initial diagnosis based on your symptoms, and will start antibiotic therapy before the final results are returned from the laboratory.

    If you smoke, quitting will reduce your risk of contracting laryngitis. Avoiding constant exposure to dust or other environmental irritants can reduce your risk as well.

    Avoid overusing your voice and refrain from excessive yelling or shouting. Stop speaking as soon as you feel minor pain. If you are in an occupation in which you use your voice extensively, consider voice therapy to learn proper breath support and less strenuous vocalization.

  • Prevention and Screening

    If you smoke, quitting will reduce your risk of contracting laryngitis. Avoiding constant exposure to dust or other environmental irritants can reduce your risk as well.

    Avoid overusing your voice and refrain from excessive yelling or shouting. Stop speaking as soon as you feel minor pain. If you are in an occupation in which you use your voice extensively, consider voice therapy to learn proper breath support and less strenuous vocalization.

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