Laryngitis Overview and Etiology

Inflammation of the larynx (voice box).

Viral upper respiratory infection (URI).

Voice changes (hoarseness, raspy voice).

Dyspnea, shortness of breath (SOB), or audible stridor

Smokers, immunocompromised individuals (weakened immune system).

Usually follows an upper respiratory infection (URI) and caused by viral organisms, bacterial possible as superinfection.

Rhinovirus, parainfluenza virus, RSV, coronavirus, adenovirus, influenza (common to rare).

Significant dysphagia (difficulty swallowing), odynophagia (painful swallowing), drooling, posturing.

The only pharmacologically treatable cause of hoarseness is chronic laryngitis associated with gastro-esophageal reflux, which responds to reflux treatment. Antibiotics and corticosteroids are not recommended for hoarseness.

Voice therapy, vocal cord surgery, and specific drug therapy are well-documented as effective treatments for hoarseness, depending on the cause and patient characteristics.

In patients with risk factors, especially smokers, hoarseness should prompt immediate evaluation by laryngoscopy.

Dysphonia describes any voice impairment, including hoarseness, restricted vocal performance, or strained vocalization.

Common causes of hoarseness include acute and chronic laryngitis, functional dysphonia, tumors (benign and malignant), neurogenic factors, aging, and psychogenic factors.

Anti-reflux medications, like H2 receptor and proton pump blockers, are used to suppress acid production and treat gastroesophageal reflux. Proton pump inhibitors are particularly effective for LPR. Higher doses or twice-daily regimens may be needed.

Proton pump inhibitors (PPIs) are the most effective anti-reflux medications for LPR-related laryngitis. These medications block acid production in the stomach.

Antihistamines and oral corticosteroids are not recommended for treating acute laryngitis as they have no proven benefit.

Acute laryngitis typically resolves on its own and carries a good prognosis. With proper treatment, full recovery to pre-illness vocal function is expected. Speech therapy can help address vocal maladaptation.

If acute laryngitis doesn't respond to treatment, underlying conditions should be considered, and referral to an ear, nose, and throat (ENT) specialist is advised for further evaluation.

Vocal rest is recommended for acute laryngitis. This means avoiding excessive talking, shouting, or singing.

Acute laryngitis is often a self-limiting condition, but it's important to be aware of potential underlying problems or mimicking conditions that may require further evaluation and medical attention.

Lifestyle modifications, dietary changes, and anti-reflux medications, particularly proton pump inhibitors, are key treatments for LPR-related laryngitis.

Cancers affecting the vocal cords, often presenting with hoarseness.

Damage to vocal cords leading to permanent hoarseness. Often caused by previous inflammation or injury.

Age-related voice changes, often involving hoarseness, due to vocal cord tissue changes.

Acid from the stomach backs up into the throat, irritating vocal cords and causing hoarseness.

Infectious disease affecting the lungs, potentially impacting the larynx, causing coughing and breathing difficulty.

An autoimmune disease causing inflammation of joints, potentially affecting the larynx, leading to hoarseness and breathing problems.

Group of diseases affecting connective tissue, potentially causing laryngeal involvement, leading to hoarseness and swallowing difficulties.

Inflammation of blood vessels, potentially affecting the larynx, causing hoarseness and breathing difficulties.

The most common cause of hoarseness, affecting 40% of cases, typically triggered by a viral infection.

Mostly caused by viruses infecting the upper respiratory tract, it's self-limiting and usually goes away within 1-2 weeks.

A temporary condition that resolves on its own after a short period, typically 1 to 2 weeks.

Acute Laryngitis is common and can affect people of all ages, a significant portion of those with hoarseness are due to this.

If the inflammation becomes severe, shortness of breath (dyspnea) or even noisy breathing (stridor) might occur.

Smokers and individuals with weakened immune systems are at a higher risk of experiencing complications.

Signs like difficulty swallowing (dysphagia), painful swallowing (odynophagia), drooling, or posturing can indicate a more serious problem.

The tracheostomy tube should be properly aligned within the trachea to avoid excessive pressure on the posterior tracheal wall, which can cause complications like airway obstruction.

If a tracheostomy tube is causing pressure on the trachea, it may need to be resized or replaced with a tube that has a more appropriate length (proximal or distal) or shape (XLT) to alleviate the issue.

The presence of a rigid tracheostomy tube along with a nasogastric tube increases the risk of tracheal pressure. Using an alternate feeding method, such as a gastrostomy tube, is recommended in these cases.

A connection between the trachea and esophagus can lead to complications like recurrent pneumonia, as food or gastric contents can enter the trachea.

A tracheoesophageal fistula typically ranges from 1 to 4 centimeters in length, meaning it affects both the trachea and the esophagus.

The cuff of the tracheostomy tube should be monitored to ensure the pressure is within a safe range of 20 to 25 mm Hg.

After a tracheostomy is performed, careful care is needed, including humidification of gases, elevation of the head of the bed, suctioning, and regular monitoring of the tube.

It is best to avoid changing the tracheostomy tube within the first five days after placement because the tract is still forming.