Laryngitis is a common disorder that involves acute or chronic inflammation of the vocal cords. Acute laryngitis may occur as an isolated infection or as part of a generalized bacterial or viral upper respiratory tract infection. Repeated attacks of acute laryngitis cause inflammatory changes associated with chronic laryngitis.
Acute laryngitis usually results from infection (primarily viral) or excessive use of the voice, an occupational hazard in certain vocations (for example, teaching, public speaking, and singing). It may also result from leisure activities (such as cheering at a sports event), inhalation of smoke or fumes, or aspiration of caustic chemicals. Causes of chronic laryngitis include chronic upper respiratory tract disorders (sinusitis, bronchitis, nasal polyps, or an allergy), mouth breathing, smoking, constant exposure to dust or other irritants, and alcohol abuse. Reflux laryngitis is caused by regurgitation of gastric acid into the hypopharynx.
Signs and symptoms
Acute laryngitis typically begins with hoarseness, ranging from mild to complete loss of voice. Associated signs and symptoms include pain (especially when swallowing or speaking), dry cough, fever, laryngeal edema, and malaise. With chronic laryngitis, persistent hoarseness is usually the only sign. With reflux laryngitis, hoarseness and dysphagia are present, but heartburn isn’t
Indirect laryngoscopy confirms the diagnosis by revealing red, inflamed and, occasionally, hemorrhagic vocal cords, with rounded rather than sharp edges and exudate. Bilateral swelling may be present. In severe cases or if toxicity is a concern, a culture of the exudate is obtained.
Primary treatment involves resting the voice. For viral infection, symptomatic care includes an analgesic and throat lozenges for pain relief. Bacterial infection requires antibiotic therapy. Severe, acute laryngitis may necessitate hospitalization. When laryngeal edema results in airway obstruction, tracheotomy may be necessary. With chronic laryngitis, effective treatment must eliminate the underlying cause. With reflux laryngitis, postural and dietary changes along with an antacid and a histamine-2 receptor antagonist combine for effective treatment.
Explain to the patient why he shouldn’t talk, and place a sign over the bed to remind others of this restriction. Provide a Magic Slate or a pad and pencil for communication. Mark the intercom panel so other facility personnel are aware that the patient can’t answer.
Minimize the need to talk by trying to anticipate the patient’s needs.
Suggest that the patient maintain adequate humidification by using a vaporizer or humidifier during winter, by avoiding air conditioning during summer (because it dehumidifies), by using medicated throat lozenges, and by not smoking. Urge him to complete the prescribed antibiotic regimen.
Obtain a detailed patient history to help determine the cause of chronic laryngitis. Encourage the patient to modify predisposing habits.