Acute Laryngitis

Updated: Jan 05, 2023
  • Author: Rahul K Shah, MD, FACS, FAAP; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Practice Essentials

Laryngitis, an inflammation of the larynx, is one of the most common laryngeal conditions identified. It manifests in acute and chronic forms. [1]

Acute laryngitis has an abrupt onset and is usually self-limited. If a patient has symptoms of laryngitis for more than 3 weeks, the condition is classified as chronic laryngitis. The etiology of acute laryngitis includes vocal misuse, exposure to noxious agents, or infectious agents leading to upper respiratory tract infections. The infectious agents are most often viral but sometimes bacterial.

See the image below.

This view depicts the larynx of a 62-year-old woma This view depicts the larynx of a 62-year-old woman with an intermittent history of exudative acute laryngitis that was treated conservatively. Courtesy of Ann Kearney, Palo Alto, Calif.

Rarely, laryngeal inflammation results from an autoimmune condition such as rheumatoid arthritis, relapsing polychondritis, Wegener granulomatosis, or sarcoidosis. A case report showed a 2-year-old intubated patient who was given activated charcoal for poisoning, resulting in obstructive laryngitis. This unusual case demonstrates the myriad potential etiologies of acute laryngitis.

Chronic laryngitis, as the name implies, involves a longer duration of symptoms; it also takes longer to develop. Chronic laryngitis may be caused by environmental factors such as inhalation of cigarette smoke or polluted air (eg, gaseous chemicals), irritation from asthma inhalers, vocal misuse (eg, prolonged vocal use at abnormal loudness or pitch), or gastrointestinal esophageal reflux. Vocal misuse results in an increased adducting force of the vocal folds with subsequent increased contact and friction between the contacting folds. The area of contact between the folds becomes swollen. Vocal therapy has the greatest benefit in the patient with chronic laryngitis.

Although acute laryngitis is usually not a result of vocal abuse, vocal abuse is often a result of acute laryngitis. The underlying infection or inflammation results in a hoarse voice. Typically, the patient exacerbates the dysphonia by misuse of the voice in an attempt to maintain premorbid phonating ability.

Signs and symptoms of acute laryngitis

In addition to symptoms of an upper respiratory tract infection (ie, fever, cough, rhinitis), the patient also experiences dysphonia or a hoarse voice. The individual may also experience the following [2] :

  • Odynophonia
  • Dysphagia
  • Odynophagia
  • Dyspnea
  • Rhinorrhea
  • Postnasal discharge
  • Sore throat
  • Congestion
  • Fatigue
  • Malaise

Workup in acute laryngitis

No laboratory studies are necessary in acute laryngitis. If the patient has an exudate in the oropharynx or overlying the vocal folds, a culture may be taken.

Direct fiberoptic or indirect laryngoscopy may be performed to provide a view of the larynx. This examination reveals redness and small dilated vasculature on the inflamed vocal folds.

Analysis of vocal fold movement reveals asymmetry and aperiodicity with reduced mucosal waves and incomplete vibratory closure. The propagation of the mucosal wave is also reduced.

Management of acute laryngitis

The following measures can help to lessen the intensity of laryngitis as the patient waits for the condition to resolve:

  • Inhaling humidified air promotes moisture of the upper airway, helping to clear secretions and exudate
  • Complete voice rest is suggested, although this recommendation is nearly impossible to follow; if the patient must speak, soft sighing phonation is best; avoidance of whispering is best, as whispering promotes hyperfunctioning of the larynx
  • Prevailing data do not support the use of antihistamines and corticosteroids

The treatment for gastroesophageal reflux disease (GERD)–related laryngitic conditions includes dietary and lifestyle modifications, as well as antireflux medications. Antacid medications that suppress acid production, such as H2-receptor and proton pump blocking agents, are highly effective against gastroesophageal reflux. Of the various classes of medicines available to treat GERD, the proton pump inhibitors are the most effective. [3, 4]



Acute laryngitis is an inflammation of the vocal fold mucosa and larynx that lasts less than 3 weeks. When the etiology of acute laryngitis is infectious, white blood cells remove microorganisms during the healing process. The vocal folds then become more edematous, and vibration is adversely affected. The phonation threshold pressure may increase to a degree that generating adequate phonation pressures in a normal fashion becomes difficult, thus eliciting hoarseness. Frank aphonia results when a patient cannot overcome the phonation threshold pressure required to set the vocal folds in motion.

The membranous covering of the vocal folds is usually red and swollen. The lowered pitch in laryngitic patients is a result of this irregular thickening along the entire length of the vocal fold. Some authors believe that the vocal fold stiffens rather than thickens. Conservative treatment measures, as outlined below, are usually enough to overcome the laryngeal inflammation and to restore the vocal folds to their normal vibratory activity.




United States

The exact prevalence of acute laryngitis is not reported because many patients often use conservative measures to treat their inflammation rather than seek medical consultation. Symptoms of an upper respiratory tract infection often accompany the disease; thus, patients are accustomed to managing their own treatment. Nevertheless, laryngitis is one of the most common laryngeal pathologies.

A study by Bhattacharyya suggested that annually about 1% of children in the United States are effected by voice or swallowing problems, with laryngitis being a common diagnosis in these cases. Using the 2012 National Health Interview Survey, the study found that an estimated 839,000 children in the United States (1.4%) reported a voice problem in the 12 months preceding the survey, with 53.5% of these youngsters having been given a diagnosis for it, the most prevalent being laryngitis (16.6%) and allergies (10.4%). [5]

A retrospective study by Roy et al indicated that among elderly members of the US population (those over age 65 years) who saw a primary care physician or otolaryngologist, acute and chronic laryngitis were among the most frequent laryngeal/voice disorder diagnoses, along with nonspecific dysphonia and benign vocal fold lesions. The study, which was based on information from a national administrative database, also found that among the elderly, women had greater odds of developing acute laryngitis than did men. [6]

A study by Benninger et al found that between 2008 and 2012, an increase in dysphonia diagnoses in the US population (from 1.3% to 1.7%) was accompanied by an associated rise in acute laryngitis diagnoses. [7]


A study by Tanislav and Kostev indicated that in Germany, there was a significant decrease in cases of acute laryngitis during the coronavirus disease 2019 (COVID-19) pandemic. The diagnoses of acute laryngitis by general practitioners were 64% lower between April 2020 and March 2021 than they were during the same period between 2019 and 2020. Among non-COVID respiratory tract infections, only influenza diagnoses saw a greater drop (71%). The investigators suggested that measures used to prevent the spread of COVID-19, such as mask wearing, social distancing, and attention to hand hygiene, may have also impacted the transmission of these other infections. [8]


Because acute laryngitis is usually self-limited and treated with conservative measures, significant morbidity and mortality are not encountered. Patients who develop acute laryngitis from an infectious etiology rather than vocal trauma may ultimately injure their vocal folds. The deficient voice production in patients with acute laryngitis may result in application of a greater adduction force or tension to compensate for the incomplete glottic closure during an acute laryngitic episode. This tension further strains the vocal folds and decreases voice production, ultimately delaying return of normal phonation.

In 1997, Ng conducted a study of the aerodynamic and acoustic characteristics of acute laryngitis. [9] His study demonstrated that across the 5 vowels, the fundamental frequency values were lower in patients with acute laryngitis than in patients with a normal voice. The authors concluded that acute laryngitis changes the vocal fold mass, resulting in a reduction of the fundamental frequency; other authors have anecdotally corroborated this finding. [10]

Patients with acute laryngitis have an increased open quotient value. This indicates that the patient's vocal folds are open longer, and less time is spent in the closed position, which contributes to the hoarseness and breathiness of the voice.

Laryngitis has a significant economic impact. Over the economic burden, pharmaceutical costs were approximately 30% of such costs. [11]


Studies have demonstrated that, usually, acute laryngitis affects individuals aged 18-40 years. Children, a category not included in the above study, are clinically observed with acute laryngitis when aged 3 years and older.