Laryngitis

We have selected the following expert medical opinion based on its clarity, reliability and accuracy. Credits: Sourced from the website Patient UK, authored by Dr Jan Sambrook and Dr Helen Huins (see below). Please refer to your own medical practitioner for a final perspective, assessment or evaluation.

Overview

Laryngitis is an inflammation of your voice box (larynx), which causes you to have a hoarse voice. It is most commonly due to an infection, usually a virus.

What is laryngitis?

Your larynx is sometimes described as your 'voice box'. It is made of two bands of muscles which stretch across the top of your windpipe (trachea). The movements and vibrations of those muscles, called the vocal cords, allow you to talk. If your voice box becomes swollen or inflamed, usually due to a viral infection. you can't talk properly anymore. Your voice becomes croaky or squeaky, and you cannot talk as loudly as usual.

Dr Sarah Jarvis MBE

Symptoms

What are the symptoms of viral laryngitis?

You may feel sore over the front of your neck and become hoarse shortly afterwards. Your voice usually sounds different to normal. It may come out as a croak or a squeak, be husky, or just sound a bit different. The voice sometimes goes and you may only be able to whisper. Some people are alarmed by this. However, it is only temporary whilst the vocal cords are inflamed during the infection. You may also have a mild high temperature (fever) and a cough. Sometimes laryngitis is part of a more widespread infection. For example, you may also have a sore throat (pharyngitis), tonsillitis, a cold or a flu-like illness.

In these situations, you may also have other symptoms such as:

• A sore throat.
• A headache.
• Feeling tired.
• Swollen glands in your neck.
• A runny nose.
• Pain when you swallow.
• General aches and pains.

How long does it last?

A typical viral laryngitis gets worse over 2-3 days. It then eases and goes, usually within a week. However, you may have a croaky voice for a week or so even after the other symptoms have gone. This is because the inflammation of the vocal cords may take a while to settle after the virus has gone.

Are there any complications?

Breathing difficulty is an uncommon complication. This may occur if there is a lot of inflammation and swelling in the voice box (larynx), which causes the windpipe (trachea) to narrow. This is rare in adults but sometimes happens in young children with smaller, narrower windpipes. See a doctor urgently if you have any difficulty in breathing with laryngitis.

Cause

What is the usual cause of laryngitis?

The voice box (larynx) joins the back of the throat to the windpipe (trachea). The vocal cords are part of the larynx and are needed for speech. Laryngitis means inflammation of the larynx. It is most often due to infection with a germ. The most common germ causing laryngitis is a virus (viral laryngitis). Other causes are much less common.

Other causes of laryngitis and hoarseness

As well as being caused by a virus, laryngitis can be caused by other germs, such as bacteria. Laryngitis may also be caused by a long period of screaming, yelling or singing very loudly. This causes your vocal cords to bang together which can make them inflamed.

If laryngitis doesn't settle after three weeks, it is called chronic laryngitis.

Causes for this include:

• Less common infections (for example, the fungal infection called thrush).
• Overuse of your voice. This is particularly common in people who use their voice in their jobs - for example, teachers, professional singers, actors.
• Allergies - for example,hay fever, allergic rhinitis, asthma.
• Reflux of acid from the stomach. Acid can travel up from the stomach and cause irritation of the throat or voice box (larynx).
• Cigarette smoke.
• Trauma or injury to your neck.
• Other diseases such as rheumatoid arthritis or systemic lupus erythematosus (SLE).
• Certain medicines - for example:
  • Steroid inhalers.
  • Antihistamines (often used for hay fever or allergy).
  • Certain blood pressure medicines such as angiotensin-converting enzyme (ACE) inhibitors and water tablets (diuretics).

A change in your voice which lasts for more than three weeks always needs checking out by your doctor.

Diagnosis

Will I need investigations?

Normally no tests are needed and the diagnosis can be made from your symptoms and from examining you. However, you will need further tests if your hoarse voice lasts for more than three weeks.

When should I see a doctor?

See a doctor if any of the following develop:

• Symptoms that are severe or are different from those described above.
• Difficulty breathing. If this happens, contact a doctor or ambulance urgently.
• A high temperature (fever) which does not start to settle after two days.
• A hoarse voice (or change in your voice) which has not settled after three weeks.
• Swollen neck glands which do not go within 2-3 weeks after an infection.
• Swollen glands in the neck without symptoms of infection.
• A lump in your neck (other than swollen neck glands, which should go away within a week or two).
• Hoarseness or loss of your voice when you have had a recent operation to your neck.

If the hoarseness in your voice does not settle in three weeks, you should always see your doctor.

You will be referred to a specialist who can look down past your throat with a special instrument called a laryngoscope. This is so they can look directly at the voice box (larynx) to find the cause of the laryngitis. Once the cause has been found, treatment can be advised. For example, if laryngitis is due to voice overuse, you may be referred to a speech therapist for exercises for your larynx. Or if it is due to acid reflux, you may need treatment for that.

Laryngoscopy also checks your hoarseness is not caused by anything more serious.

Other less common causes for a hoarse voice are:

• Non-cancerous (benign) lumps or nodules on vocal cords.
• Tumours (cancer) on the vocal cords or nearby structures.
• Problems with the nerve going to the vocal cords.

Treatment

What is the treatment for viral laryngitis?

• Not treating is an option, as laryngitis usually gets better within a few days.
• Have plenty to drink, as it is tempting not to drink very much if it is painful to swallow. You may become mildly dry (dehydrated) if you don't drink much. Mild dehydration can make headaches and tiredness much worse. Also, if your voice box (larynx) becomes dry, the inflammation gets worse. Chewing sugar-free gum can also help prevent your larynx from becoming dry.
• Paracetamol or ibuprofen will help to ease pain, headache and high temperature (fever). To keep symptoms to a minimum it is best to take a dose at regular intervals, as recommended on the packet of medication, rather than now and then.
• Aspirin gargleswill do little to ease soreness in the larynx. This is because a gargle does not touch the larynx; it only touches the back of the throat. However, it may ease a sore throat if you have this together with laryngitis. (There is little research evidence to confirm that aspirin gargles are effective for sore throat. However, it is a popular treatment and may be worth a try.) If used, dissolve some soluble aspirin in water and gargle for 3-4 minutes. You can do this 3-4 times a day. Spit out the aspirin after gargling. (Note: you should not give aspirin to children aged less than 16 years.)
• Other gargles, lozenges and sprayswhich you can buy may help to soothe a sore throat. However, again, they will do little to help with soreness in the larynx. They tend to be expensive and may do little extra to ease symptoms than the above measures.
• Breathing in moisturised (humidified) airmay help. The theory is that moisture in the airways may be soothing and may help to clear secretions. Humidifiers are available from most large pharmacies but can be expensive. Alternatively, you can place hot water in a large bowl and then breathe in the steam. Pharmacies sell a variety of devices to do this in a more convenient way. The most simple is a steam cup, which is fitted with a lid and mask. You put the boiling water in a cup, put the lid on the top and breathe through the mask. Always be careful not to burn yourself with the hot water.
• Avoid things which irritate your larynx. This includes cigarette smoke, caffeine and alcohol. 

What about using or resting my voice?

If possible, rest your voice when you have laryngitis. If you overuse your voice when the vocal cords are inflamed, it may make the inflammation worse. It is unlikely to do any permanent damage but it may take longer for your normal voice to return. Resting the voice means not shouting, singing or talking for long periods. Quiet conversation is usually fine. A sighing soft speech is best rather than whispering until the laryngitis has gone. This is because whispering makes your voice box (larynx) work harder than soft sighing speech. Once you can hum comfortably, you can probably start talking normally again.

If you are a performer such as a singer, it can be a difficult decision as to when to start singing again. Singing too early, when symptoms are easing, may prolong the hoarse voice longer than if you rest it fully until symptoms have completely gone. There is no easy answer as to the earliest it is safe to sing without doing any more harm. A professional singer may wish to consult a speech therapist if a crucial decision is to be made about an important singing engagement.

Do I need an antibiotic?

Usually not. Laryngitis is usually caused by a virus. Antibiotics do not kill viruses; they only kill bacteria. Your immune system usually clears viral infections quickly. A more severe laryngitis is sometimes due to bacteria.

An antibiotic may be advised if:

• The infection is severe.
• The infection is not easing off as expected.
• Your immune system is not working properly - for example:
  • If you have had your spleen removed.
  • If you are having chemotherapy.

About the Author

Dr Jan Sambrook (Author)

GP, Medical Author

MBChB, MRCGP

Dr Jan Sambrook qualified from the University of Sheffield in 1992.  She trained as a GP in Barnsley, and has worked for most of her career as a GP around Huddersfield, West Yorkshire. She has an interest in maternal and child health, breastfeeding and nutrition.

Dr Helen Huins (Reviewer)

MB BS Lond, DCH, DRCOG, MRCGP, JCPTGP, DFFP

Helen qualified at Guy’s Hospital in 1989 and left London in 1990 to settle in the countryside. She works as a GP partner in a rural dispensing practice and is passionate about family medicine and continuity of care with interests in sport and nutrition. Helen has been a member of the EMIS authoring team since 1995.

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