Laryngitis

Page last reviewed: 13/07/2011

Laryngitis is inflammation of the larynx (voice box). Symptoms of laryngitis include:

  • hoarseness,
  • loss of voice, and
  • sore throat.

The larynx

The larynx is a tube-like structure found at the entrance of the trachea (windpipe). The lump you can see at the front of your throat, commonly known as the Adam's apple, is your larynx.

The larynx has three main functions:

  • It helps channel oxygen into your trachea when you breathe.
  • It acts like a valve, closing off the trachea when you swallow to prevent food or liquid entering your airways. 
  • It contains two membranes (the vocal cords) which vibrate as air passes through them, producing the sound of your voice.

Laryngitis causes these membranes to become inflamed. They cannot vibrate properly, which leads to the loss of voice associated with laryngitis.

Types of laryngitis

There are two main types of laryngitis:

  • Acute laryngitis, where symptoms do not last longer than three weeks.
  • Chronic laryngitis, where symptoms persist for longer than three weeks.

Acute laryngitis

Infection is the most common cause of acute laryngitis. This is usually a viral infection, such as the common cold.

Other causes of acute laryngitis include misusing or overusing your voice, for example by shouting or singing too loud. Many professional singers have episodes of acute laryngitis.

Chronic laryngitis

Chronic laryngitis can be caused by:

  • cigarette smoke,
  • alcohol misuse,
  • gastro-oesophageal reflux disease (GORD), where acid leaks back up into the throat,
  • environmental factors, such as dust, fumes and chemicals, and less commonly
  • infections.

How common is laryngitis?

It is difficult to estimate how common acute laryngitis is because most people do not report their symptoms to their GP. However, acute laryngitis is thought to be the most common condition to affect the larynx.

Outlook

The outlook for acute laryngitis is excellent. Most people will make a full recovery within three weeks without developing complications.

The outlook for chronic laryngitis will depend on the underlying cause. All cases of chronic laryngitis needs to be investigated. If the condition is due to factors such as smoking or drinking alcohol, your symptoms should get better if you stop smoking or drinking.

In cases of GORD-associated chronic laryngitis, medication will probably be required to prevent acid from leaking up into the throat.

Page last reviewed: 13/07/2011

Symptoms of acute laryngitis can begin suddenly and usually get worse over a period or two to three days. After this time, your symptoms should improve and you will usually feel much better within a week.

The symptoms of laryngitis include:

  • hoarse voice,
  • throat pain,
  • difficulty speaking,
  • sore throat,
  • mild fever,
  • headache,
  • irritating cough, and
  • a constant need to clear your throat.

If you have laryngitis, you may not be able to talk at all, or you may only be able to whisper or croak. This will usually get worse as the day progresses and it happens because the vocal cords are inflamed. Your croaky voice may last for a week after the other symptoms have gone.

Other symptoms

Laryngitis is often linked to another illness, such as a cold, flu, throat infection (pharyngitis) or tonsillitis. Therefore, you may also experience a number of other symptoms, such as swollen neck glands, runny nose, pain on swallowing and feeling tired and achy.

Chronic laryngitis takes longer to develop and can last for weeks or even months. It can lead to lasting hoarseness as a result of permanent damage to the larynx. Chronic laryngitis commonly recurs, particularly in people who overuse their voice, such as professional singers or teachers who are unable to rest their voice for any length of time.

Occasionally, swelling of the larynx may cause breathing difficulties. This is not common in adults but can occur in young children who have smaller, narrower windpipes.

Seek medical help from your GP as soon as possible if you or your child experience difficulty breathing.

Glossary

Acute
Acute means occurring suddenly or over a short period of time.
Pain
Pain is an unpleasant physical or emotional feeling that your body produces as a warning sign that it has been damaged.
Fever
A high temperature, also known as a fever, is when someone's body temperature is 38°C (100.4°F) or higher.
Inflammation 
Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.
Chronic
Chronic usually means a condition that continues for a long time or keeps coming back.

Page last reviewed: 13/07/2011

Acute laryngitis

The causes of acute laryngitis can be either:

  • infection, or
  • damage or trauma to the larynx (sometimes referred to as mechanical laryngitis).

Infectious laryngitis

The most common type of infection associated with acute laryngitis is a viral infection, such as:

  • the common cold, or
  • influenza (flu).

Less common viral infections associated with acute laryngitis include:

  • measles,
  • mumps, and
  • the varicella-zoster virus (the virus that causes chickenpox).

Rarer types of infection include:

  • bacterial infections, such as diphtheria, and
  • fungal infections, such as thrush (candidiasis) or aspergillosis.

People with weakened immune systems, due to conditions such as HIV or as a result of treatments such as chemotherapy or steroid medication, are thought to be most at risk from fungal laryngitis.

Mechanical laryngitis

The most common cause of mechanical laryngitis is overuse or misuse of your voice.

Prolonged speaking or singing and very loud shouting or signing can cause your vocal cords to vibrate at a faster rate than they should.

The excessive vibration can damage the surface of your vocal cords, causing them to become inflamed (swollen).

Less common causes of mechanical laryngitis include:

  • direct trauma to the larynx, such as a blow to your throat, an injury sustained during a car accident or a sports injury,
  • chronic coughing, and
  • persistent and frequent clearing of your throat.

Chronic laryngitis

Causes of chronic laryngitis include:

  • Smoking: persistent exposure to tobacco smoke can cause long-term inflammation (swelling) of your larynx.
  • Alcohol misuse: the active ingredient in alcohol (ethanol) contains many impurities that can irritate your larynx.
  • Gastro-oesophageal reflux disease (GORD): stomach acid can cause inflammation and irritation of your larynx.
  • Allergic reactions to substances such as dust, fumes, chemicals and toxins.
  • Inhaled medicine for asthma may sometimes cause laryngitis.

Glossary

Chronic
Chronic usually means a condition that continues for a long time or keeps coming back.
Acute
Acute means occurring suddenly or over a short period of time.
Cyst
A cyst is a fluid-filled sac or cavity in the body.
Benign
Benign refers to a condition that should not become life-threatening. In relation to tumours, benign means not cancerous.
Bacteria
Bacteria are tiny, single-celled organisms that live in the body. Some can cause illness and disease and others are good for you.
Stomach
The sac-like organ of the digestive system. It helps digest food by churning it and mixing it with acids to break it down into smaller pieces.
Inflammation
Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.
Antibiotics
Antibiotics are medicines that can be used to treat infections caused by micro-organisms, usually bacteria or fungi. Examples of antibiotics include amoxicillin, streptomycin and erythromycin.
Shock
Shock is a short-term state of body weakness that usually happens after an accident or injury. It is caused when there is an insufficient supply of oxygen.

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Page last reviewed: 13/07/2011

Acute laryngitis

Acute laryngitis is usually a self-limiting condition. This means that the condition will get better by itself without the need for treatment. Therefore, a medical diagnosis is not usually required.

You will usually only need to contact your GP if:

  • you experience breathing difficulties,
  • you experience additional symptoms that suggest you have a more serious infection, such as high temperature (fever) above 38°C (100.4°F) and swollen glands (usually in the neck), or
  • your symptoms last for longer than three weeks.

Chronic laryngitis

If your symptoms last for longer than three weeks, your GP will probably ask you whether there are any lifestyle or occupational factors that could be causing your symptoms, such as:

  • smoking,
  • drinking alcohol,
  • overusing your voice, or
  • being exposed to potentially allergic substances.

Your GP may refer you for blood tests and take a small tissue sample from your throat using a swab (a small cotton bud with a plastic loop at the end) to check for the presence of a viral, bacterial or fungal infection.

If a reason for your chronic laryngitis cannot be found, you may be referred to an ear, nose and throat (ENT) specialist for further testing.

Your ENT specialist may recommend an MRI scan, CT scan and a biopsy (where a sample of tissue is taken to check for the presence of cancerous cells) to rule out laryngeal cancer (cancer of the larynx).

Laryngeal cancer is uncommon. However, it is important to confirm or rule out a diagnosis as soon as possible because the sooner laryngeal cancer is diagnosed, the more effective treatment will be.

Other tests that may be used include:

  • a skin allergy test to check whether you have an allergy to certain substances,
  • chest and neck X-ray to check for any abnormalities, such as an unusual narrowing or swelling of your larynx, and
  • laryngoscopy, which is a test where your larynx is examined using a mirror (an indirect laryngoscopy) or a fibre-optic camera (a direct laryngoscopy). It can be used to check if the tissue of the larynx has been damaged as a result of gastro-oesophageal reflux disease (GORD) or other causes.

A direct laryngoscopy is not painful, but the fibre-optic camera may trigger your gag reflex, which in turn can make you vomit.

The gag reflex is an automatic defence mechanism that your body uses to prevent you from accidentally choking on food. If your body suddenly senses an object near your larynx that could fall into your windpipe, you will suddenly feel a need to vomit to dislodge the object. 

To avoid this happening, the procedure is usually performed under sedation or local or general anaesthetic.

Glossary

Tissue
Body tissue is made up of groups of cells that perform a specific job, such as protecting the body against infection, producing movement or storing fat.  
Pain
Pain is an unpleasant physical or emotional feeling that your body produces as a warning sign that it has been damaged.
Biopsy
A biopsy is a test that involves taking a small sample of tissue from the body so it can be examined.
Nodules
A nodule is a small growth or lump of tissue.
Benign
Benign refers to a condition that should not become life-threatening. In relation to tumours, benign means not cancerous.
Acute
Acute means occurring suddenly or over a short period of time.

Page last reviewed: 13/07/2011

Acute laryngitis

Acute laryngitis usually gets better without treatment within a week. To help your vocal cords heal, it is important not to smoke and to avoid smoky environments. Other ways to treat laryngitis include:

  • Drink plenty of fluids, particularly water, even though swallowing may be painful. This will ensure that you do not become dehydrated.
  • Avoid excessive swallowing or coughing because it will irritate your vocal cords.
  • Painkillers, such as paracetamol or ibuprofen, taken at regular intervals, may ease any associated headaches and fever. Children under 16 years of age should not take aspirin.
  • Gargling with a mouthwash of warm, salty water and sucking lozenges will not reach the larynx, but may help soothe a sore throat. Various gargling solutions are available over-the-counter (OTC) from pharmacies. Gargle for three to four minutes, but do not swallow the solution.
  • Menthol inhalation and air humidifiers may help to clear your airways.
  • Rest your voice and avoid shouting, singing, talking or whispering for long periods. If you overuse your voice when the vocal cords are inflamed (swollen), it may make the inflammation worse and take longer for your normal voice to return.
  • Most cases of infectious laryngitis are caused by viruses, so antibiotics are not routinely prescribed. If testing shows that you have a bacterial infection, you may be given antibiotics.

Chronic laryngitis

The recommended treatment for chronic laryngitis will depend on its underlying cause.

Stop smoking if this is causing your symptoms. For information and advice on how to do it, see the Health A-Z topic on quitting smoking.

If  excessive alcohol consumption is irritating your larynx, moderate your drinking. The recommended daily alcohol limits are 3-4 units of alcohol for men, and 2-3 units for women. A unit of alcohol is equal to about half a pint of normal strength lager, a small glass of wine or a pub measure of spirits.

If your chronic laryngitis is due to gastro-oesophageal reflux disease (GORD), you may require additional treatment to better control your symptoms.

One option for treating GORD is to use proton-pump inhibitors (PPIs). PPIs reduce the amount of acid that is produced by your stomach. For more information about PPIs, see the Health A-Z topic about GORD.

If your symptoms are due to an allergic reaction, identifying and avoiding the specific substance that you are allergic to is one option. However, if this is not possible, antihistamines (a type of anti-allergy medication) can be used to help control an allergic response.

If your chronic laryngitis symptoms are due to misusing or overusing your voice, you may benefit from vocal therapy.

Vocal therapy is a type of speech and language therapy that:

  • studies how you use your voice,
  • looks at how this may contribute to your symptoms, and
  • provides you with information and advice about what changes you can make to prevent further damage to your larynx.

Glossary

Antibiotics
Antibiotics are medicines that can be used to treat infections caused by micro-organisms, usually bacteria or fungi. Examples of antibiotics include amoxicillin, streptomycin and erythromycin.
Dehydrated
Dehydration is an excessive loss of fluids and minerals from the body.
Fever
A high temperature, also known as a fever, is when someone's body temperature is 38°C (100.4°F) or above.
Nodules
A nodule is a small growth or lump of tissue.
Pain
Pain is an unpleasant physical or emotional feeling that your body produces as a warning sign that it has been damaged.
Inflammation 
Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.
Acute
Acute means occurring suddenly or over a short period of time.
Painkillers
Analgesics are medicines that relieve pain. Examples include paracetamol, aspirin and ibuprofen.

Page last reviewed: 13/07/2011

As laryngitis is a viral infection and often occurs at the same time as a cold or other infection, there is no obvious way to prevent it.

However, making small changes to your lifestyle can help. These changes should include:

  • good personal hygiene (washing your hands before and after eating and after using the toilet),
  • avoiding people who are ill, particularly if you are prone to laryngitis,
  • not smoking,
  • avoiding irritants, such as smoke, particularly if you have a cold or other respiratory infection,
  • not clearing your throat as this can make your symptoms worse (try swallowing instead), and
  • raising your head off your bed with pillows when you are sleeping. This will protect your larynx from any acid reflux from your stomach during sleep.

Professional singers or people who regularly use their voice excessively are particularly prone to laryngitis. It is essential that they receive proper training so they do not damage or misuse their voice.

Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.

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