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Laryngitis

Humza Khizer

Overview

Laryngitis is essentially an infection, irritation, or swelling of the voice box or larynx. 
&nbsp;

The vocal cords are just two folds of mucous membrane covering muscle and cartilage inside the larynx. The vocal cords normally open and close smoothly, which creates sounds.

However, the vocal cords swell up or itch in case of laryngitis. The swelling distorts the sounds and as a result, the voice sounds hoarse or even inaudible in some scenarios<a href="#accordion">[1]</a>.

Although the acute variant of laryngitis can affect a person of any age, it usually affects young adults aged 18-40 and is even seen in children as young as 3<a href="#accordion">[7]</a>. Children and infants are at a developing age so their immunities are not strong enough, hence they catch diseases quite easily.

Besides, laryngitis has been connected to all of the main respiratory viruses. Given that both viral and bacterial infections can be contagious, being in contact with a child who has it means it can be transferred to another as well. There is also a big chance that the child develops laryngitis if they yell or sing a lot<a href="#accordion">[4]</a>.

Studies also prove that the incidence of laryngitis decreases with age<a href="#accordion">[3]</a>.

According to a study in 2011, the prevalence of laryngitis was recorded to be around 6 cases per 100,000 people in the United Kingdom. While in 2012, almost 839,000 children had reported a problem with their voice that year, with laryngitis being the most common diagnosis in nearly half of these individuals<a href="#accordion">[3]</a>.

Moreover, laryngitis is seen to be more prevalent among women as compared to men. Also, generally speaking, the cases nearly double during winter as opposed to the summer season<a href="#accordion">[3]</a>.

Laryngitis essentially resolves within its first two weeks. However, if the symptoms do not go away or aggravate, it is necessary to take the opinion of a healthcare provider who can initiate a relevant treatment plan<a href="#accordion">[1]</a>. 
&nbsp;

Laryngitis is divided based on the period of the disease. The majority of laryngitis episodes are not dangerous and are brought on by a brief viral infection. If the hoarseness doesn&#39;t go away, it occasionally indicates a more serious underlying medical condition<a href="#accordion">[1]</a>.

The condition can occur in both acute and chronic forms: 
&nbsp;

1. Acute Laryngitis

Acute laryngitis is often a mild and self-limiting condition that typically lasts for a period of 3-7 days<a href="#accordion">[7]</a>. 
&nbsp;

2. Chronic Laryngitis

If the condition lasts for over 3 weeks, then it is termed chronic laryngitis<a href="#accordion">[7]</a>. 
&nbsp;

Signs and Symptoms

Laryngitis usually coexists with another condition, such as the flu or bronchitis (inflammation of a part of the lungs). In general, both children and adults present with similar symptoms, including<a href="#accordion">[5]</a>: 
&nbsp;

<ul>
	<li>Sore or raw throat, which is essentially pain, scratchiness, or irritation of the throat that often worsens while swallowing</li>
	<li>Tickling feeling in the throat</li>
	<li>Low-grade fever</li>
	<li>Hoarse voice</li>
	<li>Trouble speaking</li>
	<li>Dry cough</li>
	<li>Constant urge to clear throat</li>
	<li>Swollen glands 
	&nbsp;</li>
</ul>

Causes

Laryngitis can be due to multiple causes<a href="#accordion">[4]</a>: 
&nbsp;

Acute Laryngitis

Acute laryngitis can be caused by:

1. Viral infections similar to those that cause a cold

2. Vocal strain caused by yelling or overusing voice

3. Bacterial infections although these are less common

4. Drinking too much alcohol 
&nbsp;

Chronic Laryngitis

This type is mainly brought on by repeated irritation:

<ol>
	<li>&nbsp;Exposure to irritants, such as chemical fumes, allergens, or smoke</li>
	<li>&nbsp;Gastroesophageal reflux disease </li>
	<li>&nbsp;Chronic sinusitis</li>
	<li>&nbsp;Overusing the voice, such as singing or cheerleading</li>
	<li>&nbsp;Smoking </li>
	<li>&nbsp;Low-grade yeast infections as caused by frequent use of asthma inhaler 
	&nbsp;</li>
</ol>

Some lesser-known causes of chronic laryngitis include<a href="#accordion">[1]</a>:

<ol>
	<li>&nbsp;Bacterial or fungal infections</li>
	<li>&nbsp;Parasitic infections </li>
	<li>&nbsp;Cancer, more specifically, laryngeal cancer</li>
	<li>&nbsp;Paralysis of the vocal cord as a result of nerve injury due to surgery, injury to the chest or neck, cancer, or nervous disorders</li>
	<li>&nbsp;Distorted shape of the vocal cords 
	&nbsp;</li>
</ol>

There are currently no screening guidelines available for laryngitis. 
&nbsp;

Diagnosis

In the majority of cases, a detailed history of the patient and observation of the symptoms, like hoarseness, a sore throat, or a dry cough can be used to make a clinical diagnosis.

If the doctor suspects laryngitis, they&rsquo;ll order the following tests: 
&nbsp;

<ul>
	<li>Culture: A culture informs the doctor which organism exactly is causing the disease. The doctor examines the patient&rsquo;s throat and takes a sample via a swab. At the lab, the sample is exposed to a chemical that promotes microbial growth. If the result comes back positive, it means pathogenic microbes are present. 
	&nbsp;</li>
	<li>Laryngoscopy: A laryngoscope procedure is when the healthcare professional inserts a small camera called an endoscope through the nose or mouth to get a clearer view of the vocal cords.</li>
</ul>

Although laryngoscopies performed through the nose are not painful, they can be uncomfortable and the tube may trigger the gag reflex. The nose and throat can be numbed using a local anesthetic to minimize these uncomfortable sensations. The doctor will then ask the person to talk or sing while their larynx is being evaluated.

General anesthesia is necessary for laryngoscopy through the mouth. This means that the patient is sleeping during the test. Even though an overnight hospital stay is sometimes recommended, individuals can generally return home the same day as this procedure. 
&nbsp;

<ul>
	<li>Biopsy: The doctor will take a little sample of tissue from a nodule or lump on the vocal cords and send it to a pathology lab for examination. 
	&nbsp;</li>
</ul>

Treatment

Laryngitis treatment is dependent upon the symptoms. Based on different causes, the following class of drugs is advised: 
&nbsp;

<ul>
	<li>Antibiotics: The doctor advises antibiotics, such as erythromycin, if a bacterial infection is the cause of laryngitis<a href="#accordion">[2]</a>.</li>
	<li>Antifungals: An antifungal, such as fluconazole or itraconazole, will treat the yeast infection or candida that&rsquo;s causing laryngitis<a href="#accordion">[7]</a>.</li>
	<li>Corticosteroids: These medications, including prednisone, aid in reducing inflammation and <a href="https://merisehat.pk/disease/edema">edema</a>.</li>
	<li>Pain Relievers: Some over-the-counter pain medicines, like acetaminophen, naproxen, or ibuprofen, help alleviate symptoms such as soreness<a href="#accordion">[5]</a>. 
	&nbsp;</li>
</ul>

Some lifestyle changes and home remedies can also relieve pain:

<ul>
	<li>Voice rest is important. Don&rsquo;t talk or even whisper even during this period.&nbsp; It&rsquo;s also good to consult a speech-language therapist to learn how to take care of the voice.</li>
	<li>Consume plenty of fluids to keep the body hydrated. Avoid caffeine and alcohol.</li>
	<li>Use a humidifier. Steam (e.g., a hot shower) is another option.</li>
	<li>Avoid decongestants because they dry the throat. 
	&nbsp;</li>
</ul>

<ul>
	<li>Rarely, vocal cord irritation can result in respiratory distress, which requires urgent medical care. A bacterial infection that causes epiglottitis can infect other parts of the respiratory system, including the bloodstream, in addition to the larynx and epiglottis. </li>
	<li>Breathing and swallowing difficulties ensue due to vocal cord paralysis. Additionally, food can enter the lungs and lead to pneumonia. </li>
	<li>Advanced throat cancer can require chemotherapy or surgery. It can also be fatal. 
	&nbsp;</li>
</ul>

NOTE: Always consult a physician if your laryngitis symptoms are making it difficult for you to swallow, speak, or breathe, or if they are inflicting significant pain. Early treatment of serious laryngitis symptoms makes it easy to treat underlying issues<a href="#accordion">[4]</a>. 
&nbsp;

Risk factors for laryngitis include<a href="#accordion">[1]</a>: 
&nbsp;

<ul>
	<li>A pre-existing respiratory infection, such as a cold, bronchitis, or sinusitis</li>
	<li>Exposure to irritants, such as cigarette smoke, excessive alcohol intake, stomach acid, or workplace chemicals</li>
	<li>Overusing the voice by either speaking too much or too loudly, as in frequently shouting or singing. 
	&nbsp;</li>
</ul>

<ul>
	<li>Avoid Smoking: This includes avoiding passive smoking as well. This is because smoke dries the throat and irritates the vocal cords.</li>
	<li>Quit Alcohol: An excessive consumption of alcohol can lead to dehydration.</li>
	<li>Drink Loads Of Fluids And Limit cCffeine Intake: Fluids, especially warm ones help with the mucus flow, however the use of caffeinated drinks should be limited.</li>
	<li>Avoid Spicy Food Items: Spicy foods can cause the acid from the stomach to enter the throat or esophagus, leading to heartburn.</li>
	<li>Healthy Diet: Make sure the diet includes entire grains, fruits, and vegetables as these contain several vitamins, including vitamins A, E, and C. While these vitamins are crucial for good health in general, they support healthy throat mucous membranes.</li>
	<li>Don&rsquo;t Clear The Throat Repeatedly: This will cause abnormal vibration of the vocal cords, making them swell. Also, it causes the throat to secrete more mucus, which further irritates the larynx.</li>
	<li>Steer Clear Of Upper Respiratory Infections: Avoid contact with those who have upper respiratory illnesses, such as <a href="https://merisehat.pk/disease/cold-flu">colds</a>, and wash your hands frequently to avoid catching the infection. 
	&nbsp;</li>
</ul>

Researchers from KTU and LSMU recently evaluated the voice quality of patients after laryngectomy. They used AI technologies to facilitate and automate the post-operative process, allowing them to conditionally replace a qualified doctor &mdash; a highly praised result in the clinical study. 
&nbsp;

During the research, the team discovered the acoustic substitution voice index (ASVI), which will enable scientists in the future to objectively assess and evaluate the patient&#39;s &ldquo;substitute&rdquo; voice after oncological laryngitis using AI techniques and the acoustic parameters of the voice signal.

The ASVI&#39;s initial clinical trials also demonstrate great promise. The creation of a practical, clinically acceptable prototype to measure ASVI in a real clinical environment is another objective of the researchers. For instance, it might be a smartphone app accessible to both patients and specialists<a href="#accordion">[8]</a>. 
&nbsp;

Key Points

<ul>
	<li>Laryngitis is essentially an infection, irritation, or swelling of the voice box or larynx.</li>
	<li>According to research, the acute variant of laryngitis usually affects children.</li>
	<li>Studies also prove that the incidence of laryngitis decreases with age.</li>
	<li>Acute laryngitis is often a mild and self-limiting condition that typically lasts for a period of 3-7 days. &nbsp;</li>
	<li>If the condition lasts for over 3 weeks, then it is termed chronic laryngitis</li>
	<li>In general, both children and adults present with similar symptoms, including a sore or raw throat, which is essentially pain, scratchiness, or irritation of the throat that often worsens while swallowing, low-grade fever, and a hoarse voice.</li>
	<li>There are currently no screening guidelines available for laryngitis.</li>
	<li>A laryngoscope procedure is when the healthcare professional inserts a small camera called an endoscope through the nose or mouth to get a clearer view of the vocal cords.</li>
	<li>The doctor advises antibiotics, such as erythromycin, if a bacterial infection is the cause of laryngitis.</li>
	<li>Some lifestyle changes and home remedies can also relieve pain, including voice rest and the use of a humidifier.</li>
	<li>Risk factors for laryngitis include a pre-existing respiratory infection, exposure to irritants, and overuse of the voice. 
	&nbsp;</li>
</ul>

[1] Laryngitis (2022) Mayo Clinic. Mayo Foundation for Medical Education and Research.

[2] Caserta MT. Acute Laryngitis. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 2015;760-761.e1. doi:10.1016/B978-1-4557-4801-3.00060-6.