Laryngitis is an inflammation of your voice box (larynx) due to overuse, irritation or respiratory infection. The larynx is a framework of cartilage, muscle and mucous membrane that forms the entrance of your windpipe (trachea). Inside the larynx are your vocal cords — two folds of mucous membrane covering muscle and cartilage.
Normally, your vocal cords open and close smoothly, forming sounds through their movement and vibration. But when air escapes between the cords when it's not supposed to, your voice sounds breathy, raspy and hoarse. Your voice may sound higher or lower than normal. The sound may be due to a weak or slightly paralyzed vocal cord on one side; polyps, which are small, soft growths; or nodules, which are harder growths.
Laryngitis occurs in two forms: acute and chronic. Although acute laryngitis usually is nothing more than an irritation, persistent hoarseness can signal a more serious problem.
In laryngitis, you often feel the need to constantly clear your throat. Other signs and symptoms may include:
- Hoarseness
- Weak voice
- Tickling sensation and rawness of your throat
- Sore throat
- Swollen vocal cords
- Dry throat
- Dry cough
Causes of acute laryngitis may include:
- Illness. Usually, a viral infection such as a cold or the flu (influenza) causes acute laryngitis. A bacterial infection also may be the cause. In children, a cold may lead to croup — inflammation of the larynx and the airway just beneath it. Croup causes a loud barking cough and typically a hoarse voice.
- Irritation. Excessive talking or singing, allergies and breathing substances such as tobacco smoke and certain chemicals also can cause acute laryngitis.
Causes of chronic laryngitis may include:
- Constant irritation. Heavy smoking or excessive drinking of alcohol may inflame your vocal cords. Smoking also may cause polyps — small, soft growths on the mucous membrane covering your vocal cords. Polyps may interfere with the normal movement of your vocal cords. Smoking also can lead to cancer of the larynx. Frequent heartburn, resulting from regurgitation of stomach juices into your esophagus and throat, can cause sores (contact ulcers) on your vocal cords.
- Repeated overuse. Excessive and repeated talking or singing can cause contact ulcers or the growth of polyps or nodules on your vocal cords. Nodules differ from polyps in that nodules occur on the layer that covers the mucous membrane. Nodules are also more like calluses and not as soft as polyps. Singers may develop nodules that are sometimes called singer's nodes at the point on their vocal cords where the folds of skin come together with great pressure during singing.
- Aging. As you age, your vocal cords can lose tension. With less tension, the cords no longer vibrate as they did before.
- Nerve damage. Injury to or pressure on the nerves supplying muscles that move your vocal cords — such as a blow to your larynx during an accident — can cause vocal cord paralysis. People who have had a stroke or who have certain neurologic conditions such as amyotrophic lateral sclerosis (ALS, or Lou Gehrig's disease) may experience nerve damage and vocal cord paralysis. A tumor also can compress and destroy nerves. Depending on the cause, vocal cord paralysis may be temporary or permanent.
The following factors place you at greater risk of developing laryngitis:
- Overusing your voice, by speaking too much, speaking too loudly, shouting or singing
- Having respiratory infections, such as a cold, influenza, bronchitis or sinusitis
- Exposure to irritating substances, such as cigarette smoke, excessive alcohol, stomach acid or workplace chemicals
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When to seek medical advice
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You can manage most acute cases of hoarseness or laryngitis, including those caused by viral infections or occasional overuse, with self-care steps, such as resting your voice, drinking plenty of fluids and sucking on lozenges. If hoarseness lasts for more than 2 weeks, see your doctor. Hoarseness rarely indicates cancer of the larynx. However, hoarseness is one of the first signs of people who have cancer of the larynx.
Your doctor may ask you to describe your signs and symptoms, how long you've had them, and whether any overuse of your vocal cords — such as singing or shouting — may have irritated your vocal cords. Your doctor may also ask whether you smoke and whether any other health conditions — such as a cold, influenza or allergies — may be causing vocal irritation.
In addition, your doctor may want to listen to your voice and to look at your vocal cords. Your doctor can visually examine your vocal cords, in a procedure called laryngoscopy, by using a light and a tiny mirror to look into the back of your throat. Or your doctor may use fiberoptic laryngoscopy. This involves inserting a thin, flexible tube (endoscope) with a tiny camera and light through your nose or mouth and into the back of your throat. Then your doctor can watch the motion of your vocal cords as you speak. If a suspicious area is seen, a biopsy — taking a sample of tissue for examination under a microscope — may be done.
The treatment your doctor may recommend will depend on the cause of the laryngitis:
- If you have a respiratory infection such as a cold, your doctor may take a throat culture. For a bacterial infection such as strep throat, your doctor may prescribe antibiotics.
- If polyps are the cause of your hoarse voice, your doctor may recommend outpatient surgery to remove them. Surgery involves first using a local anesthetic, then removing the polyps using a laser or a looped wire instrument. Voice therapy may help prevent return of polyps.
- For chronic hoarseness due to a loosening of your vocal cords, surgically tightening the cords or injecting human collagen, a fibrous material, may stiffen a relaxed cord and return its normal function.
- For chronic hoarseness associated with other conditions, such as heartburn, smoking or alcoholism, managing the underlying condition can help improve voice quality. If you're a smoker and develop persistent hoarseness, see your doctor to be sure cancer isn't involved. Detected early, cancer of the larynx generally can be successfully treated with surgery or radiation.
- For treatment of vocal cord paralysis, the approach depends on the underlying cause. But treatment may include injection of collagen into the tissues adjacent to the vocal cords or thyroplasty — surgery to improve the voice by altering the cartilages of the larynx.
To prevent dryness or irritation to your vocal cords:
- Don't smoke, and avoid secondhand smoke. Smoke dries your throat and irritates your vocal cords.
- Drink plenty of water. Try to consume 6 to 8 glasses a day.
- Limit alcohol and caffeine to prevent a dry throat. If you have laryngitis, avoid both drugs.
- Avoid clearing your throat. This does more harm than good because it causes an abnormal vibration of your vocal cords and can increase swelling. Clearing your throat also causes your throat to secrete more mucus, making you want to clear your throat again.
If you have laryngitis, the following self-care steps may relieve irritation and hoarseness:
- Moisten your throat. Try sucking on lozenges, gargling with salt water or chewing gum.
- Keep the air's humidity level high throughout your home. Humidify your home to at least 50 percent humidity.
- Use an ultrasonic humidifier in your bedroom at night. Although an ultrasonic vaporizer will help keep your throat and lungs moist, it's better to use an ultrasonic humidifier than a vaporizer. The mist particles produced by an ultrasonic humidifier are smaller and more beneficial to your throat and lungs. Also, vaporizers tend to collect bacteria.
- Try eating soft, easy-to-swallow foods. Examples include applesauce, pudding, soft fruits and yogurt.
A hoarse or weak voice associated with a cold usually will go away after 2 or 3 days. To reduce strain or overuse:
- Avoid talking or singing too loudly or for too long. If you need to speak before large groups, try to use a microphone or megaphone.
- Rest your voice when you can.
- Seek voice training if you're a singer or if your voice quality is important.
- Avoid whispering, which puts even more strain on your voice than normal speech.
— June 20, 2002 —
