What is laryngitis?
Laryngitis describes inflammation of the vocal folds, no matter what the cause. As a result, it is what doctors call a nonspecific term, or a somewhat vague diagnosis. In the case of hoarseness that comes with a sore throat, cough and a fever, and lasts just a few days, laryngitis is probably an adequate diagnosis, as most such cases are viral in origin and will resolve with rest, hydration and other routine measures. Under certain circumstances, antibiotics may be appropriate, as determined by your physician.
If the voice change does not resolve as expected along with the other symptoms of a cold or flu, a cause for the laryngitis must be sought. More than likely, it is not infectious, as the body’s immune system is equipped to react to an infectious organism. The principal sources of chronic irritation of the vocal folds are laryngopharyngeal reflux, allergies and cigarette smoke, either your own or second-hand. It is also possible that there may be a small irregularity of the vocal cord, like a polyp or a cyst, that may not be noticeable unless there is some additional inflammation. This is sometimes the case in a person who notes that a cold “always goes to my vocal cords.”
‘Laryngitis’ is sometimes used simply to explain away persistent hoarseness. This is misguided, not just because it is probably inaccurate, but because hoarseness can be an early sign of a more serious problem. If there is a voice change that fails to improve for more than two or three weeks, the vocal folds themselves must be examined by a physician trained to do so. He or she should then be able to give a more specific reason for the change and recommend treatment.
What are the symptoms of laryngitis?
Laryngitis generally produces hoarseness that gets worse with voice use. If the reason for the laryngitis is infectious, then there may also be fever and a sore throat, and perhaps a cough.
What does laryngitis look like?
The vocal folds have tiny blood vessels that enlarge with irritation or infection, giving the vocal folds a bloodshot look. With a lower-resolution endoscope, like a flexible fiberoptic endoscope, this may not be apparent, and the folds may simply look pink in place of their usual white. They are usually swollen and lose their satiny sheen to look dull and rough.
Figure 1: These vocal folds show the signs of an early viral laryngitis. The vocal folds are bloodshot and there is an excess of mucous.
Figure 2A &B: Before treatment (left) and after (right) views of a case of bacterial laryngitis. Intially, the vocal folds are swolled, with redness and crusting. Pus is visible at the bottom of the picture. After a course of antibiotics, some inflammation remains, but the infection is largely cleared.
How is laryngitis treated?
Initial measures to treat laryngitis are largely a matter of common sense: rest the voice and stay well-hydrated. In most cases, this will be enough to shake off a viral infection. If there is a cough that produces a yellow- or green-colored sputum, or a coating in the back of the throat, there may be a bacterial infection that warrants antibiotics. Laryngitis that develops slowly, without fever, sore throat or other signs of infection, may represent irritation from other sources.
It cannot be stressed enough that ‘laryngitis’ is not an adequate diagnosis for hoarseness that goes on beyond two weeks. In such a case, the vocal cords must be examined to exclude another diagnosis. This is especially true in smokers, who have a high risk of laryngeal cancer.