eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Laryngology

Chronic Laryngitis, Infectious or Allergic: Treatment & Medication

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

Treatment

Medical Care

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.  A recent study failed to provide evidence to support treatment with esomeprazole 40 mg twice a day for 16 weeks compared with placebo for chronic posterior laryngitis (CPL).6
  • Supportive measures
    • 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

Surgical Care

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.

Consultations

Consultations with the following specialists may be necessary:

  • Allergists, particularly when chronic inflammation of the larynx is suspected to be secondary to allergens and/or pollutants (after excluding other potential causes)
  • Gastroenterologists
  • Pulmonologists, particularly because Wegener granulomatosis, systemic lupus erythematous, rheumatoid arthritis, and asthma affect not only the larynx but also the lungs
  • Otolaryngologists
  • Speech therapists, especially when assessing and/or rehabilitating voice and swallowing (eg, after laryngeal surgery)

Diet

If swallowing difficulties exist, then the patient must be fed according to recommendations of a speech pathologist after appropriate swallowing evaluation.

  • With GERD, avoidance of fat, alcohol, and caffeine should be practiced.
  • Foods thought to play a role in the allergic pathogenesis of the chronic laryngitis must be avoided.

Activity

If GERD is present, any habits or activities that cause acid reflux from the stomach to the esophagus (eg, lying down in bed after a rich meal, movements that may increase intra-abdominal pressure) must be avoided. Elevating the head of the bed is also beneficial. After treatable medical and surgical causes of chronic laryngitis have been resolved, voice rehabilitation under the guidance of a speech therapist is the major tool.

Medication

S aureus is a frequent causative organism in cases of chronic bacterial laryngitis. Antimicrobial therapy should cover gram-positive and gram-negative pathogens.

Antibiotics

Initial empiric antimicrobial therapy must be comprehensive and should cover both aerobic and anaerobic gram-negative organisms.


Amoxicillin and clavulanate (Augmentin)

Provides broad coverage for gram-positive, gram-negative, and anaerobic bacteria. Peak serum levels are higher than those of ampicillin. Drug combination treats bacteria resistant to beta-lactam antibiotics. Children > 3 mo, dose based on amoxicillin content. Because of different amoxicillin/clavulanic acid ratios in 250-mg tab (250/125) vs 250-mg chewable tab (250/62.5), do not use 250-mg tab until child weighs >40 kg.

Adult

250-500 mg PO q8h; alternatively, 500-875 mg PO q12h

Pediatric

<40 kg: 45 mg/kg/d PO divided bid (use 200/28.5 or 400/57 amoxicillin/clavulanate ratio)
>40 kg: Administer as in adults

Coadministration with warfarin or heparin may increase risk of bleeding

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Caution in severe renal insufficiency (decrease dose); may cause rash, pseudomembranous colitis, cholestatic jaundice, or hepatotoxicity; commonly causes diarrhea and other GI symptoms

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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