Acute Laryngitis

The most frequent cause of acute laryngitis is a viral infection, similar to those that cause the common cold or flu. Research published in the Journal of Voice (2022) suggests that over 90% of acute cases are viral in origin. When viruses invade the laryngeal mucosa, they trigger an inflammatory cascade that results in vascular congestion and fluid accumulation in the vocal folds.

Non-Modifiable Risk Factors

• Age: Children are more susceptible to infectious laryngitis due to developing immune systems.
• Anatomy: Individuals with naturally smaller or more sensitive laryngeal structures may experience symptoms more readily.

Modifiable Risk Factors

• Vocal Overuse: Excessive talking, shouting, or singing can cause mechanical trauma to the vocal folds.
• Smoking: Tobacco smoke is a potent irritant that causes chronic inflammation and weakens the laryngeal defense mechanisms.
• Alcohol Consumption: Alcohol can dehydrate the vocal fold mucosa and is often associated with vocal strain in loud environments.
• Environmental Exposure: Frequent exposure to dust, chemical fumes, or allergens.

Professional voice users are at the highest risk. According to the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS), teachers are significantly more likely to report voice disorders than the general population. Additionally, individuals with untreated Gastroesophageal Reflux Disease (GERD) are at higher risk because stomach acid can reach the larynx (Laryngopharyngeal Reflux), causing chemical irritation.

Prevention focuses on hygiene and vocal conservation. Evidence-based strategies include:

• Hand Hygiene: Frequent washing to prevent the spread of respiratory viruses.
• Vocal Hygiene: Using amplification (like microphones) in loud settings and staying hydrated to maintain the protective mucus layer on the vocal folds.
• Smoking Cessation: Eliminating irritants that cause laryngeal inflammation.

The diagnostic journey typically begins with a clinical history and a physical examination. Healthcare providers look for the duration of symptoms and any preceding upper respiratory infections. If symptoms persist longer than two to three weeks, a more detailed investigation is required to rule out chronic conditions or malignancy.

A doctor will examine the ears, nose, and throat for signs of infection. They may palpate (feel) the neck for swollen lymph nodes and observe the patient's vocal quality during conversation.

• Laryngoscopy: This is the gold standard for diagnosis. A healthcare provider uses a small mirror or a flexible fiber-optic scope (endoscope) passed through the nose or mouth to visualize the vocal folds. In acute laryngitis, the folds will appear erythematous (red) and edematous (swollen).
• Biopsy: Only performed if a suspicious lesion or mass is seen during laryngoscopy to rule out laryngeal cancer.
• Stroboscopy: A specialized type of laryngoscopy that uses a flashing light to view the vocal folds in slow motion, allowing for the assessment of vibration patterns.

It is crucial to distinguish acute laryngitis from other conditions that cause hoarseness, such as:

• Laryngopharyngeal Reflux (LPR): "Silent reflux" that irritates the larynx.
• Vocal Fold Nodules or Polyps: Benign growths caused by long-term vocal abuse.
• Spasmodic Dysphonia: A neurological disorder affecting voice muscles.
• Laryngeal Cancer: Especially in patients with a history of heavy smoking or alcohol use.

The primary goals of treating acute laryngitis are to reduce vocal fold inflammation, alleviate discomfort, and prevent the progression to chronic laryngitis. Successful treatment is measured by the return of normal vocal quality and the resolution of pain or coughing.

According to the Clinical Practice Guidelines from the AAO-HNS (2018), the standard initial approach is supportive care. This includes strict voice rest (avoiding speaking, singing, and especially whispering) and aggressive hydration. Most cases of acute viral laryngitis are self-limiting and resolve without pharmaceutical intervention.

Corticosteroids

• Mechanism: These are potent anti-inflammatory agents that work by suppressing the immune response and reducing edema in the vocal folds.
• When Preferred: Typically reserved for emergency situations (airway obstruction) or for professional voice users who have an urgent, unavoidable professional commitment.
• Side Effects: Mood changes, increased blood pressure, and increased blood glucose levels.
• Duration: Usually a short "burst" course of 3 to 7 days.

Analgesics (Pain Relievers)

• Mechanism: These medications block the production of prostaglandins, which are chemicals in the body that signal pain and inflammation.
• When Preferred: Used to manage the sore throat and general malaise associated with the condition.
• Side Effects: Gastrointestinal upset or, in rare cases, kidney or liver issues depending on the specific type used.

Antibiotics

• Note: Antibiotics are not recommended for the vast majority of acute laryngitis cases because most are viral. They may be considered only if a bacterial infection is laboratory-confirmed.

• Humidification: Using a cool-mist humidifier or inhaling steam can help soothe the irritated laryngeal lining.
• Vocal Therapy: For those with recurrent acute episodes, a speech-language pathologist can teach techniques to reduce vocal strain.

• Pregnancy: Many medications are restricted; supportive care like hydration and steam is the primary focus.
• Elderly: Healthcare providers monitor more closely for secondary infections like pneumonia.
• Children: Monitoring for signs of airway distress (croup) is paramount.

> Important: Talk to your healthcare provider about which approach is right for you.

Maintaining hydration is the most critical dietary factor. The vocal folds are covered in a layer of mucus that must remain thin and slippery to function correctly. Research suggests that systemic hydration (drinking water) is more effective than topical treatments. Avoiding caffeine and alcohol is recommended, as these substances can act as diuretics and dehydrate the laryngeal tissues. Additionally, avoiding spicy or highly acidic foods may prevent reflux-related irritation.

While moderate exercise is generally safe, patients should avoid activities that require "valsalva-like" maneuvers (holding one's breath while straining, such as heavy weightlifting), as this puts significant pressure on the vocal folds.

Elevating the head of the bed can be helpful, especially if acid reflux is suspected as a contributing factor. Adequate sleep supports the immune system in fighting the underlying viral infection.

Stress can lead to muscle tension dysphonia, where the muscles around the larynx tighten, making hoarseness worse. Techniques such as progressive muscle relaxation or deep breathing can help reduce this tension.

• Encourage the patient to use alternative forms of communication, such as texting or writing on a whiteboard.
• Ensure the environment is free of smoke and strong odors.
• Monitor the patient for any signs of worsening respiratory distress.

The prognosis for acute laryngitis is excellent. According to clinical data, the majority of cases resolve within 7 to 14 days with proper voice rest and supportive care. Most patients regain their full vocal range and quality without any long-term deficits.

• Chronic Laryngitis: If the underlying cause (like smoking or reflux) is not addressed, the inflammation can become permanent.
• Vocal Fold Hemorrhage: Rare, but can occur if a person continues to strain their voice or shout while the folds are acutely inflamed.
• Secondary Infections: In rare cases, a viral infection can weaken the tissues enough to allow a secondary bacterial infection (bronchitis or pneumonia) to take hold.

For most, no long-term management is necessary. However, individuals who experience frequent bouts of acute laryngitis should be evaluated for underlying issues like allergies, GERD, or poor vocal technique.

You should contact your healthcare provider if hoarseness lasts longer than three weeks, if you have a history of smoking, or if you notice a lump in your neck. These can be signs of more serious laryngeal pathology that requires specialized imaging or biopsy.