eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Laryngology

Chronic Laryngitis, Infectious or Allergic: Differential Diagnoses & Workup

Author: Stefano Berliti, MD, FACP, Physician, Department of Medicine - Geriatrics, Kent and Canterbury Hospital, East Kent Hospitals University Trust, UK
Coauthor(s): Michael Omidi, MD, Staff Physician, Department of Surgery, Northwestern University Memorial Hospital; Barry L Wenig, MD, MPH, FACS, Professor, Department of Otolaryngology-Head and Neck Surgery, Feinberg School of Medicine, Northwestern University; Chief, Division of Otolaryngology-Head and Neck Surgery, Evanston Northwestern Healthcare
Contributor Information and Disclosures

Updated: Aug 28, 2009

Differential Diagnoses

Chondronecrosis of the Larynx
Subglottic Stenosis in Adults
Contact Granulomas
Sulcus Vocalis
Glottic Stenosis
Vascular Lesions of the Vocal Fold
Iatrogenic Vocal Fold Scar
Vocal Fold Cysts

Workup

Laboratory Studies

  • Complete blood cell count with differential if an infection is suspected
  • Sputum cultures and sensitivities for bacteria, fungi, and viruses
  • Swab of the laryngeal mucosa, culture and sensitivities for bacteria, fungi, and viruses
  • Serologic markers for autoimmune disorders
  • Studies for tuberculosis and syphilis when such conditions are being considered

Imaging Studies

  • A lateral plain neck radiograph can help visualization of supraglottic and retropharyngeal swelling and soft tissue density in the subglottic airway. It is especially helpful in the emergency room.
  • Chest radiograph
  • CT scanning and MRI better define soft tissue alterations and provide the best information regarding the structure of the larynx.
  • Barium swallow study, double-contrast upper GI series, and manometry are often used to evaluate otolaryngologic manifestations of GERD.
  • A videostrobe is probably the single most important study after excluding a tumor. It provides significant information regarding vocal fold vibration, which can be recorded on a monitor.

Other Tests

  • Skin tests if allergies are suspected
  • Twenty-four–hour pH monitoring if GERD is in the differential diagnosis

Procedures

  • Direct examination of the larynx with flexible fiberoptic nasopharyngolaryngoscope
    • Direct laryngoscopy with a rigid laryngoscope (under general anesthesia) may be required for a detailed laryngeal inspection and may help obtain tissue for biopsy, cultures, and smears to identify the presence of organisms. Undertake this examination when noninvasive studies fail.
    • Accomplish a thorough evaluation of the aerodigestive tract, including bronchoscopy and esophagoscopy, when indicated.
    • Stroboscopic examination may help differentiate mucosal stiffness secondary to epithelial hyperplasia that may be caused by chronic inflammation.
    • Endoscopic removal of polyps and lysis of adhesions can be surgically accomplished.

Histologic Findings

Frequently, the histologic examination may not distinguish the different possibilities. For example, reflux laryngitis and pachydermia associated with long-term smoking provide a similar clinical picture. In both cases, acute and chronic inflammatory cellular infiltrates predominate, with or without epithelial hyperplasia. Different patterns of chronic tissue response can result from the following insults:

  • Infiltrative disorders (eg, amyloidosis). Lipoid proteinosis of the larynx, represented by hyaline deposits, may mimic singer's nodules or chronic laryngitis.5
  • Chronic granulomatous diseases (eg, sarcoidosis, tuberculosis, fungal laryngitis)
  • Chronic nonspecific inflammation (eg, bacterial laryngitis, laryngitis sicca)
  • Proliferative processes involving the epithelial layer, hyperkeratosis, dyskeratosis, parakeratosis, acanthosis, and cellular atypia can cause chronic tissue responses. The most extreme clinical picture is laryngeal ulceration and presence of granuloma.

More on Chronic Laryngitis, Infectious or Allergic

Overview: Chronic Laryngitis, Infectious or Allergic
Differential Diagnoses & Workup: Chronic Laryngitis, Infectious or Allergic
Treatment & Medication: Chronic Laryngitis, Infectious or Allergic
Follow-up: Chronic Laryngitis, Infectious or Allergic
Multimedia: Chronic Laryngitis, Infectious or Allergic
References
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References

  1. Ahmed TF,Khandwala F, Abelson TI, et al. Chronic laryngitis associated with gastroesophageal reflux: prospective assessment of differences in practice patterns between gastroenterologists and ENT physicians. Am. J. Gastroenerology. March 2006;101(3):470-8. [Medline].

  2. Fuchs M, Bucheler M. Chronic hyperplastic laryngitis following treatment with angiotensin converting enzyme-inhibitor. HNO. 2004;52(11):998-1000.

  3. Kania RE, Hartl DM, Badoual C, et al. Primary mucosa-associated lymphoid tissue (MALT) lymphoma of the larynx. Head Neck. 2005;27(3):258-62.

  4. Akhavan A, Ajalloueyan M, Ghanei M, Moharamzad Y. Late laryngeal findings in sulfur mustard poisoning. Clin. Toxicol (Phila). Feb. 2009;47(2):142-4. [Medline].

  5. Oz F, Kalekoglu N, Karakullukcu B, et al. Lipoid proteinosis of the larynx. J. Laryngol. Otol. 2002;116(9):736-9.

  6. Vaezi MF, Richter JE, Stasney CR, et al. Treatment of chronic posterior laryngitis with esomeprazole. Laryngoscope. February 2006;116 (2):254-60. [Medline].

  7. Bluestone, Stool, Kenna. Pediatric Otolaryngology. Vol 2. Philadelphia:. WB Saunders Co;1996:1144-52, 1253-9.

  8. Cummings CW. Otolaryngology Head and Neck Surgery. 3rd ed. St. Louis:. Mosby-Year Book;1998:1985-1992.

  9. Ebenfelt A, Finizia C. Absence of bacterial infection in the mucosal secretion in chronic laryngitis. Laryngoscope. Nov 2000;110(11):1954-6. [Medline].

  10. Fu YS, Wenig BM, Abemayor E, Wenig BL. Head and Neck Pathology. Philadelphia:. Churchill Livingstone;2001:319-323.

  11. Hanson DG, Jiang JJ. Diagnosis and management of chronic laryngitis associated with reflux. Am J Med. Mar 6 2000;108 Suppl 4a:112S-119S. [Medline].

  12. Lee KJ. Essential Otolaryngology-Head and Neck Surgery. 7th ed. Appleton & Lange;1998:830-838.

  13. Paparella MM. Otolaryngology. 3rd ed. Philadelphia:. WB Saunders Co;1991:2247-2253.

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Further Reading

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Keywords

laryngitis, chronic laryngitis, infectious laryngitis, allergic laryngitis, laryngeal mucosa, larynx, voice loss, chronic cough, airway obstruction, infectious laryngitis, allergic laryngitis, gastroesophageal reflux disease, GERD

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Contributor Information and Disclosures

Author

Stefano Berliti, MD, FACP, Physician, Department of Medicine - Geriatrics, Kent and Canterbury Hospital, East Kent Hospitals University Trust, UK
Stefano Berliti, MD, FACP is a member of the following medical societies: American College of Physicians
Disclosure: Nothing to disclose.

Coauthor(s)

Michael Omidi, MD, Staff Physician, Department of Surgery, Northwestern University Memorial Hospital
Disclosure: Nothing to disclose.

Barry L Wenig, MD, MPH, FACS, Professor, Department of Otolaryngology-Head and Neck Surgery, Feinberg School of Medicine, Northwestern University; Chief, Division of Otolaryngology-Head and Neck Surgery, Evanston Northwestern Healthcare
Barry L Wenig, MD, MPH, FACS is a member of the following medical societies: Academy of Medicine of New Jersey, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American Bronchoesophagological Association, American College of Surgeons, American Laryngological Association, American Laryngological Rhinological and Otological Society, American Medical Association, American Rhinologic Society, American Society for Head and Neck Surgery, American Society for Laser Medicine and Surgery, Association for Research in Otolaryngology, Chicago Medical Society, New York Academy of Medicine, New York Academy of Sciences, New York Head and Neck Society, Society for Ear, Nose and Throat Advances in Children, and Society of University Otolaryngologists-Head and Neck Surgeons
Disclosure: Nothing to disclose.

Medical Editor

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.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Robert M Kellman, MD, Professor and Chair, Department of Otolaryngology and Communication Sciences, State University of New York, Upstate Medical University
Robert M Kellman, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Neurotology Society, American Rhinologic Society, American Society for Head and Neck Surgery, Medical Society of the State of New York, and Triological Society
Disclosure: GE Healthcare Honoraria Review panel membership

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, 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 unstricted 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

 
 
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