Acute Laryngitis Clinical Presentation

  • Author: Rahul K Shah, MD, FACS, FAAP; Chief Editor: Arlen D Meyers, MD, MBA   more...
 
Updated: Jul 22, 2011
 

History

In addition to symptoms of an upper respiratory tract infection (ie, fever, cough, rhinitis), the patient also experiences dysphonia or a hoarse voice. A hoarse voice is defined as one that has the components of breathiness and tension.[1] These symptoms are consistent with laryngitis and are not specific for acute or chronic laryngitis. Patients with laryngitis may also experience odynophonia, dysphagia, odynophagia, dyspnea, rhinorrhea, postnasal discharge, sore throat, congestion, fatigue, and malaise.[3] The patient's vocal symptoms usually last 7-10 days. If symptoms persist longer than 3 weeks, a workup for chronic laryngitis should be performed.

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Physical

As Postma indicates, the diagnosis of acute laryngitis may be made solely based on the history and symptoms; thus, visual examination of the larynx is not always imperative. Certainly, if seen by an otolaryngologist, the patient would have a thorough examination of the head and neck, involving visual inspection of the larynx. Delay in referral to an otolaryngologist for 3 weeks may be acceptable for a primary care physician. However, an otolaryngologist who does not perform laryngoscopy in a patient with hoarseness may miss other pathologies, such as cancer, vocal nodules, or papillomas. Delaying examination of the larynx is unacceptable for an otolaryngologist.

  • Other than findings of a common upper respiratory tract infection, the patient may appear healthy.
  • Indirect examination of the airway with a mirror or direct examination with a flexible nasolaryngoscope reveals erythema and edema of the vocal folds, secretions, and irregularities of the surface contour of the vocal folds. Note the presence of normal vocal fold mobility and the absence of airway obstruction.
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Causes

Any of the following etiologies may cause acute laryngitis:

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Contributor Information and Disclosures
Author

Rahul K Shah, MD, FACS, FAAP  Assistant Professor of Otolaryngology and Pediatrics, George Washington University School of Medicine and Health Sciences; Attending Physician, Department of Otolaryngology, Children's National Medical Center

Rahul K Shah, MD, FACS, FAAP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Pediatrics, American College of Medical Quality, American College of Physician Executives, American College of Surgeons, Massachusetts Medical Society, Phi Beta Kappa, and Triological Society

Disclosure: Nothing to disclose.

Specialty Editor Board

John M Truelson, MD, FACS  Chairman, Division of Head and Neck Surgery, Associate Professor, Department of Otorhinolaryngology, University of Texas Southwestern Medical Center at Dallas

John M Truelson, MD, FACS is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society for Head and Neck Surgery, Phi Beta Kappa, and Texas Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Erik Kass, MD  Chief, Department of Clinical Otolaryngology, Associates in Otolaryngology of Northern Virginia

Erik Kass, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Association for Cancer Research, American Medical Association, and American Rhinologic Society

Disclosure: Nothing to disclose.

Christopher L Slack, MD  Private Practice in Otolaryngology and Facial Plastic Surgery, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders

Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA  Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society

Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation Unrestricted gift Unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo Consulting; Medvoy Ownership interest Management position; Cerescan Imaging Honoraria Consulting; GYRUS ACMI Honoraria Consulting

Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author Stanley Shapshay, MD, to the development and writing of this article.

References

  1. Ng ML, Gilbert HR, Lerman JW. Some aerodynamic and acoustic characteristics of acute laryngitis. J Voice. Sep 1997;11(3):356-63. [Medline].

  2. Vaughan CW. Current concepts in otolaryngology: diagnosis and treatment of organic voice disorders. N Engl J Med. Sep 30 1982;307(14):863-6. [Medline].

  3. Postma GN, Koufman JA. Laryngitis. In: Bailey BJ, ed. Head and Neck Surgery-Otolaryngology. 2nd ed. Philadelphia, Pa: Lippincott-Raven; 1998:731-739.

  4. Schalén L. Acute laryngitis in adults: diagnosis, etiology, treatment. Acta Otolaryngol Suppl. 1988;449:31. [Medline].

  5. Thompson L. Herpes simplex virus laryngitis. Ear Nose Throat J. May 2006;85(5):304. [Medline].

  6. Schalen L, Christensen P, Eliasson I, et al. Inefficacy of penicillin V in acute laryngitis in adults. Evaluation from results of double-blind study. Ann Otol Rhinol Laryngol. Jan-Feb 1985;94(1 Pt 1):14-7. [Medline].

  7. Reveiz L, Cardona AF, Ospina EG. Antibiotics for acute laryngitis in adults. Cochrane Database Syst Rev. Apr 18 2007;CD004783. [Medline]. [Full Text].

  8. Modlin IM, Moss SF, Kidd M, et al. Gastroesophageal reflux disease: then and now. J Clin Gastroenterol. May-Jun 2004;38(5):390-402. [Medline].

  9. Katz PO. Gastroesophageal reflux disease--state of the art. Rev Gastroenterol Disord. 2001;1(3):128-38. [Medline].

  10. [Guideline] Kahrilas PJ, Shaheen NJ, Vaezi MF, Hiltz SW, Black E, Modlin IM, et al. American Gastroenterological Association Medical Position Statement on the management of gastroesophageal reflux disease. Gastroenterology. Oct 2008;135(4):1383-1391, 1391.e1-5. [Medline].

  11. Donoso A, Linares M, Leon J, et al. Activated charcoal laryngitis in an intubated patient. Pediatr Emerg Care. Dec 2003;19(6):420-1. [Medline].

  12. Dworkin JP. Laryngitis: types, causes, and treatments. Otolaryngol Clin North Am. Apr 2008;41(2):419-36, ix. [Medline].

  13. Reveiz L, Cardona AF, Ospina EG. Antibiotics for acute laryngitis in adults. Cochrane Database Syst Rev. Jan 25 2005;CD004783. [Medline].

  14. Spiegel JR, Hawkshaw M, Markiewicz A, et al. Acute laryngitis. Ear Nose Throat J. Jul 2000;79(7):488. [Medline].

 
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This view depicts the larynx of a 62-year-old woman with an intermittent history of exudative acute laryngitis that was treated conservatively. Courtesy of Ann Kearney, Palo Alto, Calif.
This view depicts the larynx of a 53-year-old woman, a sixth-grade science teacher, whose chief symptom was a hoarse and breathy voice. Note the alternating areas of erythema and normal mucosa on the vocal folds. Also note irregularities in the contour of the vocal folds. Courtesy of Ann Kearney, Palo Alto, Calif.
 
 
 
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