Skip to Main Content

1. ACUTE LARYNGITIS

Acute laryngitis is probably the most common cause of hoarseness, which may persist for a week or so after other symptoms of an upper respiratory infection have cleared. The patient should be warned to avoid vigorous use of the voice (singing, shouting) until their voice returns to normal, since persistent use may lead to the formation of traumatic vocal fold hemorrhage, polyps, and cysts. Although thought to be usually viral in origin, both M catarrhalis and H influenzae may be isolated from the nasopharynx at higher than expected frequencies. Despite this finding, a meta-analysis has failed to demonstrate any convincing evidence that antibiotics significantly alter the natural resolution of acute laryngitis. Erythromycin may speed improvement of hoarseness at 1 week and cough at 2 weeks when measured subjectively. Oral or intramuscular corticosteroids may be used in highly selected cases of professional vocalists to speed recovery and allow scheduled performances. Examination of the vocal folds and assessment of vocal technique are mandatory prior to corticosteroid initiation, since inflamed vocal folds are at greater risk for hemorrhage and the subsequent development of traumatic vocal fold pathology.

+
Jaworek  AJ  et al. Acute infectious laryngitis: a case series. Ear Nose Throat J. 2018 Sep;97(9):306–13.
[PubMed: 30273430]

2. LARYNGOPHARYNGEAL REFLUX

ESSENTIALS OF DIAGNOSIS

  • Commonly associated with hoarseness, throat irritation, and chronic cough.

  • Symptoms typically occur when upright, and half of patients do not experience heartburn.

  • Laryngoscopy is critical to exclude other causes of hoarseness.

  • Diagnosis is made based on response to proton-pump inhibitor therapy.

  • Treatment failure with proton-pump inhibitors is common and suggests other etiologies.

Gastroesophageal reflux into the larynx (laryngopharyngeal reflux) is considered a cause of chronic hoarseness when other causes of abnormal vocal fold vibration (such as tumor or nodules) have been excluded by laryngoscopy. Gastroesophageal reflux disease (GERD) has also been suggested as a contributing factor to other symptoms, such as throat clearing, throat discomfort, chronic cough, a sensation of postnasal drip, esophageal spasm, and some cases of asthma. Since less than half of patients with laryngeal acid exposure have typical symptoms of heartburn and regurgitation, the lack of such symptoms should not be construed as eliminating this cause. Indeed, most patients with symptomatic laryngopharyngeal reflux, as it is now called, do not meet criteria for GERD by pH probe testing and these entities must be considered separately. The prevalence of this condition is hotly debated in the literature, and laryngopharyngeal reflux may not be as common as once thought.

Evaluation should initially exclude other causes of dysphonia through laryngoscopy; consultation with an otolaryngologist is advisable. Many clinicians opt for an empiric trial of a proton-pump inhibitor since no gold standard exists for diagnosing this condition. Such an empiric trial should not precede visualization of the vocal folds to exclude other causes of hoarseness. When used, the American Academy of Otolaryngology—Head and Neck Surgery recommends twice-daily ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.