Acute Laryngitis

Intro & Etiology - Voice Box Vexation

• Inflammation of laryngeal mucosa, < 3 weeks duration.
• Etiology:
  • Infective (most common):
    • Viral: Adenovirus, Rhinovirus, Influenza, Parainfluenza, RSV.
    • Bacterial (secondary): Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis.
  • Non-infective:
    • Vocal abuse/misuse.
    • Irritants: Smoke, pollutants, GERD.
    • Allergies.
    • Trauma (e.g., intubation).

⭐ Viral infections are the most frequent cause of acute laryngitis.

Clinical Features - Hoarse & Sore Story

• Hoarseness (Dysphonia): Cardinal symptom; voice quality is rough, breathy, or strained. May progress to aphonia.
• Sore throat (Odynophagia): Mild to moderate pain, often described as rawness or irritation.
• Dry, irritating cough.
• Constitutional symptoms: Low-grade fever, malaise, myalgia (common with viral etiology).
• Laryngoscopic findings:
  • Vocal cords: Diffusely erythematous and edematous.
  • Mucosal congestion, sometimes with sticky secretions.
  • Vocal cord mobility usually normal.

⭐ Hoarseness is the earliest and most characteristic symptom of acute laryngitis.

Diagnosis & DDx - Spotting the Strain

• Diagnosis: Primarily clinical (hoarseness, cough, mild sore throat post-URI).
  • Laryngoscopy (IDL or Flexible NPL): Shows diffuse laryngeal erythema & edema, especially of vocal folds. Vocal fold mobility typically normal.
• Key DDx:

  Condition	Differentiating Features
  Diphtheritic Laryngitis	Greyish membrane, toxemia, bull neck
  Acute Epiglottitis	Severe dysphagia, drooling, muffled "hot potato" voice
  Croup (LTB)	Barking cough, inspiratory stridor (mainly children)
  Laryngeal Cancer	Persistent hoarseness, smoker, weight loss

⭐ Hoarseness lasting >3 weeks, particularly in smokers or elderly, mandates laryngoscopy to exclude laryngeal malignancy.

Management - Soothing the Sound

• Pillars of Care:
  • Voice Rest: Absolute silence is golden.
  • Hydration & Humidification: Steam, fluids.
  • Irritant Avoidance: No smoking/alcohol.
• Symptom Control:
  • Analgesics/Antipyretics for pain/fever.
• Medications (Selective Use):
  • Antibiotics: Only for clear bacterial infection (purulence, high fever >38.5°C).
  • Corticosteroids: For professionals or severe edema (e.g., Prednisolone 0.5-1 mg/kg).
• Follow-up:
  • Refer to ENT if symptoms persist >2-3 weeks or red flags (e.g., stridor, dysphagia) emerge.

⭐ Whispering is often more traumatic to vocal cords than soft, breathy phonation; complete voice rest is paramount.

Complications & Prevention - Beyond the Croak

• Complications (Uncommon):
  • Persistent dysphonia
  • Progression to chronic laryngitis
  • Vocal cord injury (nodules, polyps) from continued voice abuse
  • Airway obstruction (severe edema; extremely rare in adults)
• Red Flags (Urgent Evaluation):
  • Hoarseness > 3 weeks
  • Hemoptysis, odynophagia, severe dysphagia
  • Stridor, neck mass, unexplained weight loss
  • No improvement despite voice rest
• Prevention:
  • Strict voice rest during acute phase
  • Vocal hygiene: adequate hydration, avoid smoke/alcohol/irritants
  • Manage predisposing factors (GERD, allergies, sinusitis)
  • Humidification; avoid shouting/straining voice

⭐ Hoarseness lasting over 3 weeks, particularly in an elderly smoker, necessitates laryngoscopy to exclude laryngeal carcinoma.

High‑Yield Points - ⚡ Biggest Takeaways

• Etiology: Predominantly viral (rhinovirus, influenza, parainfluenza, adenovirus).
• Cardinal symptom: Hoarseness (dysphonia); may progress to aphonia.
• Laryngoscopy: Shows diffuse vocal cord edema and erythema; hyperemia.
• Management cornerstone: Voice rest (complete or relative) and steam inhalation/hydration.
• Antibiotics: Not routinely recommended; reserve for suspected bacterial infection.
• Prognosis: Typically self-limiting, resolving within 7-10 days; hoarseness may persist longer.
• Red flags: Stridor, severe dysphagia, or symptoms >3 weeks warrant further investigation.