Infectious or Allergic Chronic Laryngitis Treatment & Management
- Author: Stefano Berliti, MD, FACP; Chief Editor: Arlen D Meyers, MD, MBA more...
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 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).
A study by Mirić et al suggested that in patients with GERD and chronic laryngitis, gas diffusion capacity should be controlled, even when lung function is normal. The study included 30 children with chronic or recurrent laryngitis who tested positive for GERD. Increases in reflux indexes correlated with decreases in values for single-breath diffusing capacity of the lung for carbon monoxide (DLCO); ie, the odds for a significant reduction in the DLCO increased by 3.9% and 5.5% for each unit change in the Johnson-DeMeester and Boix-Ochoa scores, respectively.
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.
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)
- Pulmonologists, particularly because Wegener granulomatosis, systemic lupus erythematous, rheumatoid arthritis, and asthma affect not only the larynx but also the lungs
- Speech therapists, especially when assessing and/or rehabilitating voice and swallowing (eg, after laryngeal surgery)
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.
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.
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. 2006 Mar. 101(3):470-8. [Medline].
Fuchs M, Bücheler M. [Chronic hyperplastic laryngitis following treatment of hypertension with angiotensin converting enzyme-inhibitor]. HNO. 2004 Nov. 52(11):998-1000. [Medline].
Kania RE, Hartl DM, Badoual C, Le Maignan C, Brasnu DF. Primary mucosa-associated lymphoid tissue (MALT) lymphoma of the larynx. Head Neck. 2005 Mar. 27(3):258-62. [Medline].
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].
Hiraga A, Kamitsukasa I, Araki N, Yamamoto H. Hoarseness in pellagra. J Clin Neurosci. 2011 Jun. 18(6):870-1. [Medline].
Witt DR, Chen H, Mielens JD, et al. Detection of chronic laryngitis due to laryngopharyngeal reflux using color and texture analysis of laryngoscopic images. J Voice. 2014 Jan. 28(1):98-105. [Medline]. [Full Text].
Oz F, Kalekoglu N, Karakullukçu B, Oztürk O, Oz B. Lipoid proteinosis of the larynx. J Laryngol Otol. 2002 Sep. 116(9):736-9. [Medline].
Vaezi MF, Richter JE, Stasney CR, et al. Treatment of chronic posterior laryngitis with esomeprazole. Laryngoscope. February 2006. 116 (2):254-60.
Myerson DN, DeFatta RA, Sataloff RT. Acute laryngitis superimposed on chronic laryngitis. Ear Nose Throat J. 2013 Feb. 92(2):60-3. [Medline].
Bluestone, Stool, Kenna. Pediatric Otolaryngology. Vol 2. Philadelphia:. WB Saunders Co. 1996:1144-52, 1253-9.
Cummings CW. Otolaryngology Head and Neck Surgery. 3rd ed. St. Louis:. Mosby-Year Book. 1998:1985-1992.
Ebenfelt A, Finizia C. Absence of bacterial infection in the mucosal secretion in chronic laryngitis. Laryngoscope. 2000 Nov. 110(11):1954-6. [Medline].
Fu YS, Wenig BM, Abemayor E, Wenig BL. Head and Neck Pathology. Philadelphia:. Churchill Livingstone. 2001:319-323.
Hanson DG, Jiang JJ. Diagnosis and management of chronic laryngitis associated with reflux. Am J Med. 2000 Mar 6. 108 Suppl 4a:112S-119S. [Medline].
Lee KJ. Essential Otolaryngology-Head and Neck Surgery. 7th ed. Appleton & Lange. 1998:830-838.
Paparella MM. Otolaryngology. 3rd ed. Philadelphia:. WB Saunders Co. 1991:2247-2253.