Infectious or Allergic Chronic Laryngitis Follow-up

• Hospital admission is necessary when signs and symptoms of toxemia exist and intravenous antibiotic therapy is needed (eg, severe bacterial or fungal infections).
• ICU monitoring may be required when stridor or any other symptom suggesting important involvement of the airways exists. This may occur in the late stages of diseases, such as Wegener granulomatosis, rheumatoid arthritis, relapsing polychondritis, or amyloidosis, or with conditions that severely compromise the structure and functions of the larynx. Airway monitoring becomes of paramount importance.
• When a risk of aspiration exists, alternative forms of feeding may be used until the risk subsides.
• When contagious diseases are suspected, the appropriate isolation procedures must be implemented before identification of the responsible organisms and initiation of the indicated medical treatment.
• Further inpatient care is required for all cases in which verification of the response to the therapy and its optimization prior to discharge are needed.
• If chronic laryngitis is part of a systemic disease, then the treatment plan must take into account the different necessities that vary from case to case.

• Further outpatient care is indicated whenever adherence to therapy may not be optimal and verification is believed to be necessary.
• Further outpatient care is indicated when prophylactic and epidemiological recommendations must be reinforced (eg, abstinence from cigarette smoking, airborne isolation and medical treatments for household contacts of a patient with tuberculosis).
• Further outpatient care is indicated when the physician wants to ensure that the pathologic findings of the larynx are regressing according to treatment plan expectations.

Transfer may be problematic only when respiration is compromised and risk of acute insufficiency exists. In these circumstances, preventive measures must be undertaken, and appropriate surgical instrumentation to perform a tracheostomy should be available.

• The most difficult problems that occur in patients with chronic laryngitis are as follows:

  • Systemic spread or spread to the surrounding structures of the eventual infectious process
  • Laryngeal stenosis due to acute suprainfection of a chronic situation and consequent edema or stenosis secondary to a long-term process that has not been addressed
  • Vocal cords with excessive reactive growth and permanent damage to their structure and, consequently, to their function
  • Transformation into cancer

• Prognosis mainly relates to the causative process.

• Detailed information regarding occupational/environmental substances and/or habits that might have caused a patient's chronic laryngitis must be provided. Strategies to avoid the causative factors and their consequences must be taught.
• Avoidance of cigarette smoking and secondhand smoke are of paramount importance.
• A speech therapist must be consulted when voice rehabilitation is needed. Recommend appropriate use of the voice.
• Educate patients regarding appropriate handling of medications. Inhaled corticosteroids may cause chronic laryngitis, presumably because of the local immunosuppressive effect, thus causing oral candidiasis. Inhaled corticosteroids can cause dysphonia, probably secondary to a myopathic effect. These effects can be minimized through dose reduction, switching to twice-daily administration, mouth rinsing, and the use of a spacer device.
• Patients should be aware that obesity is a risk factor for the development of GERD, probably related to increased intra-abdominal pressure.
• For excellent patient education resources, visit eMedicine's Ear, Nose, and Throat Center. Also, see eMedicine's patient education article Laryngitis.