Laryngitis

What is laryngitis?

Laryngitis means inflammation and irritation of the larynx, which is commonly referred to as the voice box or vocal cords in your throat. Most cases of laryngitis are caused by a virus infection but there are many other possible causes (see 'Laryngitis causes' below). When caused by a virus infection, it usually starts suddenly and resolves within 1-2 weeks.

What is the larynx?

Your larynx is made of two bands of muscles which stretch across the top of your windpipe (trachea) in your upper respiratory tract. 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 may become croaky or squeaky, and you may find you cannot talk as loudly as usual.

Laryngitis symptoms

Common symptoms of laryngitis include:

• Soreness over the front of your neck and throat.

• Hoarseness.

• A mild temperature.

• A dry cough.

• A croaky voice or difficulty speaking.

Some people are alarmed by their trouble speaking. However, it is only temporary whilst the vocal cords are inflamed during the infection.

Sometimes laryngitis is part of a more widespread infection. For example, you may also have a sore throat (pharyngitis), tonsillitis, a cold or 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 laryngitis last?

Viral laryngitis typically gets worse over 2-3 days. It then eases and goes away, 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 can take a while to settle after the virus has gone.

Laryngitis causes

The causes of laryngitis include:

Acute laryngitis

• Infection. Laryngitis is most often due to infection with a germ. The commonest germ causing laryngitis is a virus (viral laryngitis) although bacteria and fungi can also be causes of laryngitis. Other causes are much less common.

• Vocal stress. 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.

Chronic laryngitis

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 or candida).

• 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 - actively smoking or secondhand smoke (passive smoking).

• 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.

Is laryngitis contagious?

When laryngitis is caused by an infection (for example, a virus), the infection can be contagious. However, the types of infection that cause laryngitis are not usually highly contagious ones.

These types of infection are usually spread through respiratory droplets, propelled through the air when a person coughs or sneezes. The infection may also be present in saliva and passed on through kissing.

Complications of laryngitis

Breathing difficulty is an uncommon complication with laryngitis. 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.

How is laryngitis diagnosed?

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.

Taking a culture

Sometimes your doctor may decide to take a culture to confirm which type of infection is causing your laryngitis. Your doctor will use a flat stick (tongue depressor) to press down your tongue and then rub a clean cotton swab over the back of your throat. This is sent for laboratory analysis to check for infection. The results usually takes a few days to come back.

Laryngoscopy

This is a test that looks closely at the larynx with a laryngoscope. A laryngoscope is a thin metal tube with a light on the end. It is passed through your nose and into your throat so that the doctor can take a good look at your larynx. A local anaesthetic spray is usually used before the procedure, to numb the area.

Completing a biopsy

If your doctor wants to take a sample (biopsy) of your larynx this is done under general anaesthetic (you will be asleep). The biopsy is a small piece of tissue from your larynx that is removed so that it can be examined under a microscope. This test is used to check for cancer of the larynx and tuberculosis.

When should I contact a doctor about laryngitis?

Contact 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.

You will be referred to an ear, nose and throat 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

• 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.

Laryngitis treatment

Not treating is an option

As laryngitis usually gets better within a few days, you could try to wait for the symptoms to go away on their own.

Drink plenty of fluids

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.

Take paracetamol or ibuprofen

These will help to ease pain, headache and high temperature (fever). To keep symptoms to a minimum it is best to take a dose of paracetamol or ibuprofen at regular intervals, as recommended on the packet of medication, rather than now and then.

Aspirin gargles

This will 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 sprays

These 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) air

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.

Antifungals

When laryngitis is caused by fungal infection, the treatment is antifungal medication. These include: miconazole, nystatin and fluconazole.

Corticosteroids

Sometimes corticosteroid medication (either oral or inhaled) is recommended to treat laryngitis as it is thought to reduce swelling in the larynx. However, the research is not clear on whether there is a definite benefit to this or not.

Rest your 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.

Singing and laryngitis
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 antibiotics for laryngitis?

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 bacterial infections.

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.