Introduction
Laryngitis is swelling and inflammation of the larynx. It can be acute or chronic, although in most cases the condition is temporary and has no serious consequences.
The larynx, also referred to as the voice box, is home to the vocal cords. These are vital to the processes of breathing, swallowing, and talking. The vocal cords are two small folds of mucous membrane covering cartilage and muscle that vibrate to produce sound. The vocal cords normally open and close to generate the voice with a slow, steady movement. When a person has laryngitis, their vocal cords are swollen. This changes the way air moves through the throat.
This change in airflow leads to a distortion of the sounds that the vocal cords produce. People with laryngitis will often have a voice that is hoarse, gravelly, or too quiet to hear properly.
In chronic laryngitis, the inflammation is ongoing. Vocal cords can become strained and develop growths, such as polyps or nodules.
Laryngitis is not often serious and, in most cases, resolves without treatment in around 7 days.
- Acute laryngitis is commonly due to infection. The basic pathophysiology is inflammation of the mucosa lining the vocal folds and larynx. If infection is involved, white cells aggregate to remove infectious material from the area. Oedema of the laryngeal lining increases the amount of pressure required to produce sound, resulting in dysphonia or aphonia. Changes to the structure of the larynx may also result in a lower register of speech.
- Chronic laryngitis can be due to a variety of different causes, including reflux, allergy, trauma and autoimmune disease. Depending on the cause, there may be laryngeal spasm, hyperaemia, oedema, inflammation and various changes to the morphology of the laryngeal mucosal cells.
Signs & symptoms
Symptoms in adults.
- Hoarse voice
- Dysphagia
- Globus pharynges (feeling of a lump in the throat)
- Continual throat clearing
- difficulty to speak
- throat pain
- low grade fever
- persistent cough
- frequent throat clearing
Laryngitis related with other diseases like tonsilitis, throat infection, cold, or flu can present itself with:
- headache
- swelling in the glands
- runny nose
- pain while swallowing
- fatigue and malaise
Symptoms in children
Symptoms of laryngitis in children can differ from symptoms in adults. The condition is often characterized by a hoarse, barking cough and fever, and may also present as croup.
Croup is a contagious respiratory illness common among children. Although croup is usually a simple illness to treat, severe cases require medical attention.
Causes
- Viral infections such as Rhinoviruses, Adenoviruses, Influenza viruses, Herpes viruses, HIV
- Bacterial infection – may co-exist with viral infection:
Streptococcus pneumoniae, Staphylococcus aureus, Group B beta-haemolytic streptococci, Moraxella catarrhalis, Klebsiella pneumoniae.
- Less commonly mycobacterial and syphilitic infection.
- Fungal Infection like Candidiasis.
- Immunosuppression and the use of steroid inhalers.
- Lung cancer.
- Thyroid disease.
- Exposure to irritant substances or temperature change.
- Voice abuse.
- Gastro-Esophageal Reflux Disease (GERD)
- History of asthma
- History of allergy
- Immunocompromised patients – consider candida involvement.
- Drugs like calcium-channel blockers, nitrates, beta-blockers, progesterone.
- Immunosuppressant therapies like candida.
- Inhalation treatments – thermal baths.
- History of intubation
- Thoracic and abdominal surgeries
- Neck trauma.
- Autoimmune diseases (e.g., amyloidosis, systemic lupus erythematosus, granulomatosis with polyangiitis, rheumatoid arthritis).
- Environmental pollutants.
- Contagious diseases – e.g., tuberculosis.
- Smoking, recreational abuse, alcohol intake.
- History of syphilis.
- Diet – chocolate, caffeine.
- Diphtheria
Pathophysiology
Acute laryngitis is an inflammation of the vocal fold mucosa and larynx that lasts less than 3 weeks. When the aetiology of acute laryngitis is infectious, white blood cells remove microorganisms during the healing process. The vocal folds then become more oedematous, and vibration is adversely affected. The phonation threshold pressure may increase to a degree that generating adequate phonation pressures in a normal fashion becomes difficult, thus eliciting hoarseness. Frank aphonia results when a patient cannot overcome the phonation threshold pressure required to set the vocal folds in motion.
The membranous covering of the vocal folds is usually red and swollen. The lowered pitch in laryngitic patients is a result of this irregular thickening along the entire length of the vocal fold. Some authors believe that the vocal fold stiffens rather than thickens. Conservative treatment measures, as outlined below, are usually enough to overcome the laryngeal inflammation and to restore the vocal folds to their normal vibratory activity.
Diagnosis
Physical examination including listening to the voice, for hoarseness.
Laryngoscopy
Biopsy
- Laboratory tests:
- FBC with differential to exclude infection.
- Sputum culture for bacteria, fungi and viruses.
- Laryngeal mucosal swab for microbiological analysis.
- Serology for autoimmune markers.
- Tests for syphilis and tuberculosis
- Endoscopy
- Imaging:
- Lateral X-ray of the neck
- Chest X ray.
- CT and MRI scanning
- Barium swallow study, double-contrast upper gastrointestinal series and manometry – may be considered to exclude GORD.
Treatments
Acute laryngitis
- Most cases are mild and self-limiting.
- It is relieved with rest, home remedies, and self-care measures in most of the cases.
- “Vocal hygiene” or a group of self-help measures including:
- Resting the voice. For laryngitis, rest means limiting the use of the larynx. Avoid talking, singing, or using the voice box. Although whispering may seem like a gentler alternative to speaking at normal volume, this requires that the vocal cords are tightly stretched, hampering their recovery. Whispering should also be avoided.
- Avoidance of smoking and alcohol (both are irritants, and alcohol causes dehydration).
- Humidification – promotes moisture of the upper airway, helping to clear secretions and exudate.
- Hydration – chewing sugar-free gum and/or increasing fluid intake (250 ml per hour awake).
- Reducing caffeine (as it causes dehydration, reflux and snoring).
- Antibiotics have a limited effect only, especiallly in the initial management of acute laryngitis.
- Antibiotics will be helpful in patients who have persistent fever, purulent sputum, associated with any other disease or immune deficiency.
Chronic laryngitis
- Voice hygiene methods as described above.
- Voice therapy – exercises with the help of a speech therapist will help in some cases. This modifies voice and use of vocal cords to reduce trauma to the larynx.
- Treat the underlying conditions such as GERD
- Corticosteroids to reduce vocal cord inflammation in severe or urgent cases especially for people who use the voice professionally, such as professional singers or public speakers. Infants with severe croup may also receive a course of corticosteroids.
- Surgery in cases where the vocal cords have been badly damaged as a result of polyp or nodule growth.
Prognosis
Laryngitis can be uncomfortable, but it is easily manageable and often short-lived.
In acute laryngitis, the prognosis is usually excellent. With chronic laryngitis the prognosis depends on the underlying condition.
Complications
- Acute laryngitis is usually self-limiting and complications are rare. But overstrain to speak may cause damage to vocal cords.
- Chronic laryngitis
Loss of voice,
Obstruction of the airways
Chronic cough
Laryngeal stenosis
Laryngeal erosion and necrosis (Rarely, in severe infections such as those with herpes virus)
Disease & Ayurveda
Swarasaada
Nidana
Rajayakshma
Purvaaroopa
Not mentioned
Samprapti
In a patient with Rajayakshma or with causative factors for each dosha individually or together, the doshas get lodged in throat and produce problems in speech.
Lakshana
Kshaama-rooksha-chalaswara – Feeble, dry, and unstable voice
Sookapoornabhakanthatwa – Feelinbg of spikes in throat
Taalugaladaaha – Burning in throat and palate
Kantham limpan iva – Feeling of coating in throat
Khurakhurayate – Hoarse voice
Divisions
- Vaatika
- Paittika
- Kaphaja
- Thridoshaja
- Medoja
Prognosis
Saadhya – single dosha involved
Asadhya – Thridoshaja and Medoja
Chikithsa
Treatment depends upon the doshakopa indeed.
Samana
Vaatika
- Uttarabhaktikaghrutapanam
- Gudodanam+sarkara
- Payasam
Paittika
- Ksheerivrikshankuraghruta+milk
- Yshteemadhukapayasam
Kaphaja
- Katurasa oushadha
- Rookshaanna
- Rookshadravya lehana
In case of talking in high pitch- drink milk processed with madhurarasadravyas and sarakara & honey
Sodhana
Teekshnam vamanam in Kaphajaswarasada
Commonly used medicines
Vacharudrakshachoornam
Kallyanavalehachoornam
Taleesapatradi choornam
Brands available
AVS Kottakal
AVP Coimbatore
Vaidyaratnam oushadhasala
Home remedies
- Limit dryness and irritation to the vocal cords
- Avoid clearing the throat.
- Take steps to prevent upper respiratory infections, such as practicing good hygiene and avoiding contact with people who have contagious infections.
- Limit or eliminate caffeine intake, as this can increase the risk of dehydration.
- Gargling with salt water. Salt water may decrease inflammation and make swallowing less painful. Mix 8 ounces (oz) of warm water with 1 teaspoon (tsp) of salt and gargle this solution several times a day.
- Sipping warm drinks. Warm drinks, such as herbal tea, may help decrease pain. Avoid making the liquid too hot, or it can burn the throat.
- Taking a hot shower. The steam from a hot shower may help to decrease any inflammation responsible for painful swallowing.
- Avoiding alcohol and tobacco. Substances in alcohol and tobacco can irritate the soft tissue of the mouth, throat, and food pipe.
Diet
- To be avoided
Drinking ice-cold water – loss of appetite and increased kapha leads to respiratory problems.
Heavy meals and difficult to digest foods – cause indigestion.
Junk foods- cause disturbance in digestion and reduces the bioavailability of the medicine
Carbonated drinks – makes the stomach more acidic and disturbed digestion
Refrigerated and frozen foods – causes weak and sluggish digestion by weakening Agni (digestive fire)
Milk and milk products – increase kapha and cause respiratory problems
Curd – causes vidaaha and thereby many other diseases
- To be added
Light meals and easily digestible foods
Green gram, soups, honey.
Freshly cooked and warm food processed with cumin seeds, ginger, black pepper, ajwain etc
Behaviour:
Protect yourself from cold climate.
Give voice rest to the needed extend
Better to avoid exposure to excessive sunlight, wind, rain or dust.
Maintain a regular food and sleep schedule.
Avoid holding or forcing the urges like urine, faeces, cough, sneeze etc.
Yoga
As laryngitis is a localised inflammation, stretching and cardiac exercises are advised. Also, specific yogacharya including naadeesuddhi pranayama, bhujangaasana, is recommended.
In persons with fever and respiratory infections, physical exercises are not recommended.
Regular exercise after regaining normal health helps improve bioavailability of the food ingested and leads to positive health.
Yoga can maintain harmony within the body and with the surrounding system.
Nadisudhi pranayama
Bhujangasana
Simple exercises for lungs and heart health
All the exercises and physical exertions must be decided and done under the supervision of a medical expert only.
Research articles
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6486127/
https://www.ncbi.nlm.nih.gov/books/NBK534871/
Author information
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