Acute Laryngitis Clinical Presentation

Updated: Oct 12, 2017
  • Author: Rahul K Shah, MD, FACS, FAAP; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Presentation

History

In addition to symptoms of an upper respiratory tract infection (ie, fever, cough, rhinitis), the patient also experiences dysphonia or a hoarse voice. A hoarse voice is defined as one that has the components of breathiness and tension. [5] These symptoms are consistent with laryngitis and are not specific for acute or chronic laryngitis. Patients with laryngitis may also experience odynophonia, dysphagia, odynophagia, dyspnea, rhinorrhea, postnasal discharge, sore throat, congestion, fatigue, and malaise. [8] The patient's vocal symptoms usually last 7-10 days. If symptoms persist longer than 3 weeks, a workup for chronic laryngitis should be performed.

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Physical

As Postma indicates, the diagnosis of acute laryngitis may be made solely based on the history and symptoms; thus, visual examination of the larynx is not always imperative. Certainly, if seen by an otolaryngologist, the patient would have a thorough examination of the head and neck, involving visual inspection of the larynx. Delay in referral to an otolaryngologist for 3 weeks may be acceptable for a primary care physician. However, an otolaryngologist should perform a laryngoscopy in a patient with hoarseness without delay in order to avoid missing other pathologies, such as cancer, vocal nodules, or papillomas.

Other than findings of a common upper respiratory tract infection, the patient may appear healthy.

Indirect examination of the airway with a mirror or direct examination with a flexible nasolaryngoscope reveals erythema and edema of the vocal folds, secretions, and irregularities of the surface contour of the vocal folds. Note the presence of normal vocal fold mobility and the absence of airway obstruction.

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Causes

Infection (usually viral upper respiratory tract infection), including with the following, can cause acute laryngitis [8] :

Other causes of acute laryngitis include the following:

A report notes herpes simplex virus as another viral etiology. [9] The role of rhinitis and the unified airway points to the fact that patients with rhinitis are more prone to manifest with dysphonia and laryngitis. [10]

A study by Bhattacharyya indicated that infectious laryngitis is the most common diagnosis in adults with voice problems in the United States. Analyzing cases from the 2012 National Health Interview Survey, Bhattacharyya estimated that 17.9 million adults reported voice problems in the 12 months preceding the survey, with an estimated 685,000 cases having been diagnosed with infectious laryngitis and an estimated 308,000 having been diagnosed with GERD. [11]

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