Infectious or Allergic Chronic Laryngitis Workup

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

Laboratory Studies

  • 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
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Imaging Studies

  • A lateral plain neck radiograph can help visualization of supraglottic and retropharyngeal swelling and soft tissue density in the subglottic airway. It is especially helpful in the emergency room.
  • Chest radiograph
  • CT scanning and MRI better define soft tissue alterations and provide the best information regarding the structure of the larynx.
  • Barium swallow study, double-contrast upper GI series, and manometry are often used to evaluate otolaryngologic manifestations of GERD.
  • A videostrobe is probably the single most important study after excluding a tumor. It provides significant information regarding vocal fold vibration, which can be recorded on a monitor.
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Other Tests

  • Skin tests if allergies are suspected
  • Twenty-four–hour pH monitoring if GERD is in the differential diagnosis
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Procedures

  • Direct examination of the larynx with 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 differentiate mucosal stiffness secondary to epithelial hyperplasia that may be caused by chronic inflammation.
    • Endoscopic removal of polyps and lysis of adhesions can be surgically accomplished.
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Histologic Findings

Frequently, the histologic examination may not distinguish the different possibilities. For example, reflux laryngitis and pachydermia associated with long-term smoking provide a similar clinical picture. In both cases, acute and chronic inflammatory cellular infiltrates predominate, with or without epithelial hyperplasia. Different patterns of chronic tissue response can result from the following insults:

  • Infiltrative disorders (eg, amyloidosis). Lipoid proteinosis of the larynx, represented by hyaline deposits, may mimic singer's nodules or chronic laryngitis.[6]
  • Chronic granulomatous diseases (eg, sarcoidosis, tuberculosis, fungal laryngitis)
  • Chronic nonspecific inflammation (eg, bacterial laryngitis, laryngitis sicca)
  • Proliferative processes involving the epithelial layer, hyperkeratosis, dyskeratosis, parakeratosis, acanthosis, and cellular atypia can cause chronic tissue responses. The most extreme clinical picture is laryngeal ulceration and presence of granuloma.
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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

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  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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