Acute Laryngitis refers to the sudden inflammation of the larynx, or voice box, which is responsible for sound production. Located in the upper respiratory tract, the larynx vibrates when air passes through the vocal cords, creating sound. Acute laryngitis is typically caused by viral infections but can also result from bacterial infections, vocal strain, or irritants. The term “acute” indicates a condition with a short duration, rather than one with a long-standing or chronic nature.

What is Acute Laryngitis?

Acute laryngitis is the sudden inflammation of the mucosa of the larynx, often caused by viral infections like rhinovirus, influenza virus, or parainfluenza virus. The condition usually leads to hoarseness, voice changes (Dysphonia), or in some cases, temporary voice loss, depending on the severity of the inflammation. Acute laryngitis typically resolves on its own and is managed with conservative measures such as staying hydrated, using humidification, resting the voice, and providing reassurance. It is important to avoid whispering, as it can exacerbate irritation to the larynx.¹

Role of Larynx

The larynx, or voice box, is an essential structure in the human respiratory system, located in the neck. It is composed of muscles, vocal cords, and cartilage. These components are critical for both breathing and speaking. The larynx’s cartilage gives it structural support and stability across a range of activities, while the surrounding muscles regulate the vocal cords’ tension and position, crucial for producing a variety of sounds. The vocal cords themselves, made up of specialized tissue layers, vibrate to produce speech.

The inflammation of the larynx that happens during laryngitis is frequently brought on by bacterial or viral infections. Speaking difficulties, throat soreness, and a raspy or harsh voice can all be symptoms of this illness. The inflammation may also impact speech quality by disrupting the normal function of the vocal cords.²

Illustration depicting larynx inflammation in laryngitis — Anatomy of the Larynx

Etiology of Acute Laryngitis

Acute laryngitis is a multifactorial disease.³ It has various causes. For instance,

Infectious Causes:

Viral Infections

Acute laryngitis can be caused by several viral infections.⁴ Common viruses include influenza, parainfluenza, rhinovirus, and adenoviruses, all of which can lead to upper respiratory infections that, in turn, may result in acute laryngitis. Respiratory Syncytial Virus (RSV) is a frequent cause of respiratory illness in children, though it more commonly leads to bronchiolitis rather than laryngitis.

Bacterial Infections

Bacterial infections are less common than viral infections in acute laryngitis but can still occur.⁵ The bacteria most often associated with acute laryngitis include Haemophilus influenzae and Streptococcus species. While bacterial infections generally respond well to antibiotics, they are typically secondary infections that arise after a viral illness weakens the immune system.

Non-Infectious Causes:

Environmental Factors & Allergies

The larynx has a very sensitive membrane. It is irritated easily. When the air quality index is within normal range, it shows no hypersensitivity reactions. However, when the air quality reduces due to environmental pollutants like smoke and allergens, the laryngeal mucosa gets irritated. In other situations, some people have jobs in factory areas. These whereabouts are dense with pollutants and it irritates their mucosa when they breathe the same air.

Voice Strain

Excessive voice use, such as speaking loudly or shouting, can lead to laryngitis. However, voice strain typically requires prolonged or repetitive use to result in laryngeal inflammation. This condition is often seen in individuals who speak for long periods, such as teachers, performers, or those who talk frequently.

GERD

Stomach acid refluxing into the esophagus can irritate the laryngeal mucosa, leading to symptoms of laryngitis. However, while GERD is associated with laryngeal irritation, studies have found no direct link between reflux-induced laryngitis and esophagitis in patients with GERD symptoms.⁶

Autoimmune Diseases

Autoimmune diseases, such as psoriasis and rheumatoid arthritis, can impair the immune system’s ability to combat infections. As a result, individuals with autoimmune conditions are more susceptible to acquiring laryngitis, as their immune system struggles to fend off infections that may affect the larynx.

Symptoms of Acute Laryngitis

Acute laryngitis may present with the following symptoms:

Hoarseness:

Hoarseness refers to a rough, raspy, or strained voice caused by irregular vibrations of the vocal cords. In acute laryngitis, inflammation and swelling of the vocal cords interfere with their normal movement, resulting in changes in voice quality.

Pain & Irritation

A feeling of discomfort, pain, or generalized irritation might be experienced by a patient with acute laryngitis.

Persistent Cough & Breathlessness

One of the most common symptoms of laryngitis is cough. Breathlessness is not a hallmark of typical laryngitis but may occur if inflammation significantly narrows the airway, particularly in children.

Dysphonia

Dysphonia refers to an impairment in the ability to produce voice sounds due to dysfunction of the vocal cords. It may range from hoarseness to complete voice loss.

Dysphagia

Dysphagia means difficulty in swallowing. Patients of acute laryngitis find it difficult to swallow food, water and in the worst situations their own saliva as well.

Fever & Fatigue

Inflammation is mostly followed by fever & fatigue. This occurs due to the body’s natural immune response. Cytokines are released which induce a systemic response. This systemic response appears in the form of fever and malaise.

Diagnosis of Acute Laryngitis

Diagnosis is typically clinical and involves evaluating the patient’s history and symptoms, alongside a physical examination. Using a light source and tongue depressor, a healthcare provider inspects the throat for signs of inflammation. If symptoms persist or worsen, further investigations may be recommended.
These tests include:

Throat Culture

A throat culture is done with a sample collected from a throat swab. It helps in the identification of the exact cause of acute laryngitis.

Blood Tests

Blood tests such as a complete blood count (CBC) may be ordered to assess for infection or inflammation

Laryngoscopy

In severe or prolonged cases, a laryngoscope may be used. It provides a visual aid to view the inner anatomy of the larynx. Swelling, inflammation, or any other sort of abnormalities can be viewed.⁷

Treatment of Acute Laryngitis

Most cases of acute laryngitis are self-limiting and improve with conservative care. Treatment strategies include:

Voice Rest

It is necessary for the patient to limit conversations. When the patient talks less and only upon necessity, it gives the larynx a break. It helps reduce strain on the vocal cords and speeds recovery.

Humidification & Hydration

An increase in fluid and water intake will promote healing. This soothes and relieves the throat. People may use air humidifiers for the purpose of humidification of the air.

Limited Exposure to Irritants

The patient may wear a face mask to prevent exposure to air pollutants and irritants like smoke and strong odors. This is necessary when acute laryngitis is due to environmental issues.

Lozenges

Lozenges are available over the counter. They are one of the ideal soothers of the throat. Fruity flavors are added to the lozenges for a better taste.

Analgesics (Pain Killers)

Over-the-counter pain relievers like acetaminophen or ibuprofen may help reduce discomfort.

Antibiotics

These are only indicated if a bacterial infection is confirmed or strongly suspected. Overuse or misuse of antibiotics should be avoided to prevent resistance. A common issue is the self-prescription of antibiotics, often under the assumption that laryngitis is always bacterial. This is not only incorrect but also contributes to antibiotic resistance. Co-Amoxiclav is frequently overused and may be ineffective in viral cases.
Antihistaminics and oral steroids have no role in treatment.⁸

Rest

As the patient with laryngitis often experiences fever and malaise, resting helps to regain energy.

Is Acute Laryngitis Contagious?

The contagiousness of acute laryngitis depends entirely on its etiology. If it has taken place due to a viral or bacterial infection, it will most probably be contagious. It can then spread via respiratory droplets, and nasal secretions when the infected person sneezes, coughs, or talks. However, if laryngitis is due to some sort of trauma, or habit, then it is not contagious.
In order to prevent the spread of laryngitis, the infected person must adopt good hygiene. Good hygiene practice involves frequent handwashing, the use of face masks, and covering the face while sneezing and coughing.

Special Types of Laryngitis

Acute Spasmodic Laryngitis

Children most commonly experience acute spasmodic laryngitis.⁹ It is characterized by sudden, spontaneous severe episodes of laryngeal spasm. It is often known as croup. Spasmodic laryngitis occurs commonly at night. Consequently, the patient has bouts of uncontrollable bark-like cough which is difficult to stop. The second most common feature of this type of laryngitis is stridor. Stridor is basically a high-pitched sound heard during inhalation.

Acute Obstructive Laryngitis

Acute obstructive laryngitis also commonly affects young children. The usual age bracket is between 6 months and 3 years. The larynx has different parts and in case of acute obstructive laryngitis, the subglottis becomes inflamed. The distinctive feature is the feeling of obstruction in the throat. This results in a seal-like cough and severe respiratory distress. However, it resolves by itself once the inflammation and infection subsides. Medical help must be sought if it does not settle within a few days.

Wrap-Up

To sum it up, acute laryngitis is one of the most common throat infections. It most commonly affects children due to various parafunctional habits, environmental factors, and infections. Diverse symptoms are observed. Likewise, the treatment varies from hydration in the mildest cases to antibiotic administration.

Refrences

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Acute Laryngitis: Causes, Symptoms, and Care

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