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Īsthma may predispose to laryngitis due to chemical irritation from inhaler use, and chronic steroid inhaler use can predispose to fungal laryngitis, particularly if patients are not drinking plain water after their steroid inhaler use as instructed. Singers may note a loss of their higher range. Hallmarks include a history of GERD, frequent throat-clearing or coughing, globus pharyngeus sensation, or coarseness to the voice. They may not follow or accompany the classic GERD symptoms, and 1/3 of patients with GERD will experience only laryngeal/voice symptoms. These symptoms can be acute or chronic and may be episodic. Gastroesophageal reflux (GERD), more specifically extra-esophageal GERD, termed laryngopharyngeal reflux (LPR), is an exceptionally common cause of voice symptoms and laryngitis. This can also be seen in vocal performers, particularly those whose performance intensity or frequency has increased recently, and who have not had formal voice or singing coaching. This is common in coaches, fans, and athletes after an event. Vocal misuse or abuse can be acute in onset, as seen after a day or days of shouting/yelling. Īcute non-infectious laryngitis can be due to vocal trauma/abuse/misuse, allergy, gastroesophageal reflux disease, asthma, environmental pollution, smoking, inhalational injuries, or functional/conversion disorders. This may present with isolated vocal symptoms, but classically includes a characteristic "barking" cough and may progress to inspiratory or biphasic stridor. These same agents are common in pediatric acute laryngitis, though it is important to remember croup (laryngotracheobronchitis) in children, which is due to parainfluenza virus (most commonly parainfluenza-1).
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Laryngitis caused by fungal infection is very rare in immunocompetent individuals, and more often presents as chronic laryngitis in the immunocompromised or in patients using inhaled steroid medications.Īcute infectious laryngitis in adults is most commonly caused by the viral organisms listed above. Exanthematous febrile illnesses such as measles, chickenpox, and whooping cough are also associated with acute laryngitis symptoms, so it is prudent to obtain an accurate immunization history. The most commonly encountered bacterial organisms are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis, in that order. It is possible for bacterial superinfection to occur in the setting of viral laryngitis, this classically occurs approximately seven days after symptoms begin. Viral agents such as rhinovirus, parainfluenza virus, respiratory syncytial virus, coronavirus, adenovirus, and influenza are all potential etiologic agents (listed in roughly descending order of frequency). The infectious form is more common and usually follows an upper respiratory tract infection.
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The etiology of acute laryngitis can be classified as either infectious or non-infectious. Similarly, the presence of significant dysphagia, odynophagia, drooling, or posturing are very rare in simple acute laryngitis and warrant additional workup.
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Suspicion should be heightened in smokers and the immunocompromised, as these patients are at higher risk for malignancy and more dangerous infections that may otherwise mimic acute laryngitis. Breathing difficulties are rare (though possible) in acute laryngitis, but the presence of significant dyspnea, shortness of breath (SOB), or audible stridor should alert the clinician that a more dangerous disease process may be present.
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Presenting symptoms often include voice changes (patients may report hoarseness or a "raspy" voice), early vocal fatigue (particularly in singers or professional voice users), or a dry cough. In the absence of infectious history or sick contacts, additional causes of non-infectious laryngitis must be explored. The most common cause of acute laryngitis is viral upper respiratory infection (URI), and this diagnosis can often be obtained from taking a thorough history of present illness from the patient. If this condition lasts for over 3 weeks, then it is termed as chronic laryngitis. Acute Laryngitis is often a mild and self-limiting condition that typically lasts for a period of 3 to 7 days. Laryngitis refers to inflammation of the larynx and can present in both acute and chronic forms.