Infectious or Allergic Chronic Laryngitis Treatment & Management

  • Author: Stefano Berliti, MD, FACP; Chief Editor: Arlen D Meyers, MD, MBA   more...
 
Updated: Aug 11, 2011
 

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).[7]
  • 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
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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.
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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)
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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.
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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.

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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.

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

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; Revent Medical Honoraria Review panel membership

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

References

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

  2. Fuchs M, Bücheler M. [Chronic hyperplastic laryngitis following treatment of hypertension with angiotensin converting enzyme-inhibitor]. HNO. Nov 2004;52(11):998-1000. [Medline].

  3. Kania RE, Hartl DM, Badoual C, Le Maignan C, Brasnu DF. Primary mucosa-associated lymphoid tissue (MALT) lymphoma of the larynx. Head Neck. Mar 2005;27(3):258-62. [Medline].

  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. Hiraga A, Kamitsukasa I, Araki N, Yamamoto H. Hoarseness in pellagra. J Clin Neurosci. Jun 2011;18(6):870-1. [Medline].

  6. Oz F, Kalekoglu N, Karakullukçu B, Oztürk O, Oz B. Lipoid proteinosis of the larynx. J Laryngol Otol. Sep 2002;116(9):736-9. [Medline].

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

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

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

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

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

  12. 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].

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

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

 
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Illustration of the larynx.
Illustration of the glottic and supraglottic larynx.
Illustration of the larynx, posterior view.
Illustration of the larynx, nasopharyngeal view.
Illustration of the intrinsic muscles of the larynx, sagittal view.
Illustration of the intrinsic muscles of the larynx, sagittal view.
Illustration of the extrinsic muscle insertions of the larynx.
Illustration of the intrinsic muscles of the larynx, superior view.
Illustration of the intrinsic muscles of the larynx.
 
 
 
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