Laryngitis: Causes, Diagnosis, Treatment and Voice Care
Laryngitis is inflammation of the larynx, especially the vocal-fold mucosa, producing hoarseness, voice fatigue or temporary loss of voice. Acute disease is commonly viral; persistent dysphonia requires visualisation to exclude structural, neurological or malignant disease.
Hoarseness with stridor, breathing difficulty, haemoptysis, neck mass, dysphagia, severe pain, weight loss or tobacco exposure needs prompt ENT assessment. Persistent unexplained hoarseness should be visualised.
Learning objectives
- Distinguish acute from chronic laryngitis.
- Identify infectious, irritant and phonotraumatic causes.
- Outline appropriate examination and treatment.
- Teach safe voice care and recognise red flags.
Causes
| Category | Examples |
|---|---|
| Acute infectious | Usually viral upper-respiratory infection; bacterial or fungal causes are less common and occur in selected settings. |
| Voice trauma | Shouting, prolonged speaking, singing with poor technique or repeated throat clearing. |
| Irritants | Tobacco, smoke, dust, chemical exposure, inhaled drugs and dehydration. |
| Chronic inflammatory | Laryngopharyngeal reflux, allergy/post-nasal drip, chronic infection and autoimmune disease. |
| Alternative pathology | Vocal nodules/polyps, paralysis, papillomatosis, tumour or functional voice disorder. |
Clinical features
- Hoarse, weak, rough, breathy or strained voice.
- Voice fatigue, reduced pitch range or aphonia.
- Throat discomfort, dryness, cough and frequent throat clearing.
- Features of viral illness in acute cases.
Simple acute laryngitis usually develops with an upper-respiratory infection and improves within days. Severe systemic illness, drooling or airway noise is atypical and should prompt another diagnosis.
Assessment and diagnosis
- Establish duration, onset, vocal demand and progression.
- Ask about smoking, reflux symptoms, allergy, inhaled medicines, intubation, surgery and neurological symptoms.
- Assess airway, voice quality, oral cavity, neck and cranial nerves.
- Flexible laryngoscopy is indicated for persistent, recurrent, atypical or high-risk symptoms.
- Videostroboscopy evaluates mucosal vibration; imaging or biopsy is selected when a mass, paralysis or deeper lesion is suspected.
Antibiotics, cultures and imaging are not routine for uncomplicated viral laryngitis.
Management
Acute uncomplicated laryngitis
- Relative voice rest: speak gently and briefly; avoid shouting and prolonged whispering.
- Hydration and humidified air where helpful.
- Appropriate analgesia and treatment of accompanying viral symptoms.
- Avoid tobacco smoke, alcohol excess and drying irritants.
Routine antibiotics are not useful when disease is viral. Corticosteroids are not routine and should be reserved for selected clinician-assessed situations because they can mask symptoms and encourage vocal overuse.
Chronic or recurrent disease
- Eliminate tobacco and occupational irritants.
- Optimise inhaler technique and rinse the mouth after inhaled corticosteroids.
- Treat confirmed reflux, allergy, fungal infection or other cause.
- Use voice therapy for inefficient technique or phonotrauma.
- Remove or biopsy selected lesions under specialist care.
Urgent performance pressure does not remove the need for examination. Singing or speaking forcefully through pain or sudden dysphonia can worsen haemorrhage or mucosal injury.
Important differential diagnoses
Severe pain, fever, drooling, muffled voice or respiratory distress.
Breathy voice, weak cough, aspiration or stridor depending on laterality.
Persistent progressive hoarseness, especially with tobacco/alcohol risk, neck mass or weight loss.
Prevention and voice care
- Use amplification rather than shouting in noisy settings.
- Schedule voice breaks and maintain hydration.
- Avoid smoking and second-hand smoke.
- Replace throat clearing with a sip of water or gentle swallow where appropriate.
- Seek assessment for recurrent or persistent change.
Review the anatomy of the larynx and physiology of phonation.
Key examination points
- Acute laryngitis is usually viral.
- Voice rest means reduced gentle use, not forceful whispering.
- Routine antibiotics are usually unnecessary.
- Chronic dysphonia requires cause-directed care and often laryngoscopy.
- Stridor or respiratory distress is an airway emergency.
References and further reading
For education only. Apply current Uganda Clinical Guidelines, local protocols and specialist advice.
