Infectious or Allergic Chronic Laryngitis

Updated: Jun 08, 2017
  • Author: Stefano Berliti, MD, FACP; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Overview

Practice Essentials

Chronic laryngitis is a current topic of interest, primarily because of newly identified etiopathogenetic factors related to the change in the quality of environmental pollutants and toxic products found in workplaces. The continuous evolution of such factors constitutes a challenge for medical experts, who must update their knowledge of new toxic/irritative materials being used by the industrial market. The need to implement strategies that recognize the deleterious effects on the human body and to use necessary corrective therapies represents a very active research field. Symptoms of chronic laryngitis can be present in otherwise healthy people.

Illustration of the larynx. Illustration of the larynx.

Diagnosis

Laboratory studies in chronic laryngitis include the following:

  • 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 include the following:

  • Lateral plain neck radiograph
  • Chest radiograph
  • Computed tomography (CT) scanning and magnetic resonance imaging (MRI)
  • Barium swallow studies, double-contrast upper gastrointestinal (GI) series, manometry
  • Videostrobe

Skin tests can be performed if allergies are suspected, as can 24-hour pH monitoring if gastroesophageal reflux disease (GERD) is in the differential diagnosis.

The larynx can be directly examined with a 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 to differentiate mucosal stiffness secondary to epithelial hyperplasia that may be caused by chronic inflammation.

Management

Medication therapies directed mainly against the causative agents vary on a case-by-case basis. With GERD, H2-receptor antagonists, proton pump inhibitors, and prokinetics are the main classes of drugs used.

Supportive measures include the following:

  • Hydration with about 2 liters of fluid intake per day
  • Steam inhalation or room humidifier
  • Avoidance of pollutant or irritative/toxic substances
  • Identification and avoidance of environmental and occupational sensitizers - Limitation of exposure or change in the work environment if noxious fumes and organic solvents are responsible; avoidance of cigarette smoking, even secondhand smoke

From a therapeutic standpoint, the following procedures may be indicated:

  • Reduction of stenosis is indicated if infiltrative processes or conditions, such as amyloidosis, Wegener granulomatosis, rheumatoid arthritis, or systemic lupus erythematous, have significantly narrowed the lumen of the larynx; aggressive surgical intervention may be required
  • Exophytic mass removal by surgical means
  • Laser vaporization
  • Laparoscopic antireflux surgery, using the Nissen fundoplication technique, has shown appreciable results in the treatment of GERD
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Pathophysiology

Chronic laryngitis refers to an inflammatory process that determines irreversible alterations of the laryngeal mucosa. Reactive and reparative processes of the larynx represent the main pathogenetic factor, which can persist even when the causative stimulus ends. Depending on the causes, the pattern of changes can be very different. Inflammation, edema, hyperemia, and infiltration and proliferation of the mucosa can represent different levels of response to insults.

The inflammatory process damages the ciliated epithelium of the larynx, particularly in the posterior wall. This impairs the important function of moving the mucous flow out of the tracheobronchial tree. When the ciliary beating motion of the epithelium is impaired, the resultant mucous stasis on the posterior wall of the larynx and around the vocal cords provokes a reactive cough. Mucous across the vocal cords may manifest with laryngospasm. Significant changes may arise in the vocal cord epithelium in the form of hyperkeratosis, dyskeratosis, parakeratosis, acanthosis, and cellular atypia.

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Epidemiology

Frequency

United States

The authors found no data regarding precise frequency. Because chronic laryngitis is usually part of a more complex disease, it is probably underreported.

Mortality/Morbidity

Chronic laryngitis presents a frustrating treatment problem. Voice loss, chronic cough, and airway obstruction, respectively, are the most likely complications. An association with cancer of the larynx is unclear. Mortality is obviously related to the main disease with which chronic laryngitis is associated.

Race

The condition apparently affects all races equally.

Sex

Traditionally, men have been mostly affected. In recent reports, a 2:1 male predominance still exists; however, the trend is changing, probably because of more women smoking cigarettes and their increasing involvement in work activities in toxic environments.

Age

Adults in the sixth decade of life are mainly affected. Neonates and infants share similar risk factors with adults for developing chronic laryngitis. Additionally, various congenital lesions of the larynx may present with voice changes.

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