Chronic Laryngitis

Intro & Etiology - Larynx Under Siege

Chronic laryngitis: Persistent laryngeal inflammation lasting > 3 weeks. Results in mucosal changes (hyperemia, edema, leukoplakia) due to prolonged irritation.

• Etiology - Key Factors:
  • Vocal abuse/misuse: singers, teachers (📌 "Talker's Triad")
  • Irritants: Smoking (primary), alcohol, pollutants, industrial fumes
  • Laryngopharyngeal Reflux (LPRD): Silent reflux often implicated
  • Infections: Chronic bacterial, fungal (Candida), viral, TB
  • Allergies & chronic rhinosinusitis
  • Systemic: Autoimmune (Wegener's), hypothyroidism

⭐ Laryngopharyngeal Reflux (LPRD) is a very common cause, often presenting with globus, chronic cough, or hoarseness without typical GERD symptoms.

Types & Symptoms - Hoarse Whispers

• Cardinal Symptom: Persistent hoarseness (dysphonia); voice may be rough, breathy, or weak.
• Common Accompanying Symptoms: Vocal fatigue, throat clearing, globus sensation, mild chronic cough, throat discomfort.
• Key Types & Distinguishing Features:
  • Reinke's Edema: Bilateral, diffuse vocal fold swelling. Low-pitched, husky voice. Strongly linked to smoking.
  • Atrophic Laryngitis: Dry, shiny mucosa; crusting. Sensation of dryness, irritation.
  • Tuberculous Laryngitis: Hoarseness, significant odynophagia. Posterior larynx often affected.
  • Fungal Laryngitis: White plaques on erythematous mucosa. Risk: inhaled corticosteroids, immunocompromise.

⭐ In Reinke's Edema, the characteristic low-pitched, "smoker's voice" is due to increased mass of the vocal folds from fluid in Reinke's space.

Diagnosis - Peeking at the Cords

• Laryngoscopy (Indirect/Flexible/Direct): Cornerstone of diagnosis.
  • Reveals: Vocal cord erythema, edema, thickened/dull mucosa.
  • May show: Leukoplakia, Reinke's edema, interarytenoid changes (pachydermia).
• Biopsy: Mandatory for suspicious lesions (leukoplakia, erythroplakia, persistent ulcer/mass) to exclude malignancy. ⭐ > Any unilateral vocal cord lesion in an adult, especially a smoker, is considered malignant until proven otherwise by biopsy.
• Stroboscopy: Evaluates vocal fold vibration & mucosal wave; differentiates organic vs. functional issues.
• Consider underlying causes: GERD/LPR (pH study if suspected), allergies, irritant exposure.

Management - Soothing the Strain

• Primary Approach:

• Conservative Pillars:
  • Voice Rest: Crucial. Absolute then relative. Avoid whispering.
  • Vocal Hygiene: ↑Hydration, cease smoking, avoid alcohol/irritants.
  • Steam Inhalation: Soothes mucosa.
• Targeted Therapies:
  • Treat GERD (PPIs), sinusitis, allergies.
  • Speech Therapy: Corrects vocal abuse/misuse; improves technique. 📌 Essential for long-term success.
  • Medications: Mucolytics. Antibiotics (rarely, for superinfection). Steroids (short course for severe edema, use cautiously).
  • Surgery: For polyps, Reinke's edema, leukoplakia (biopsy).

⭐ For Reinke's edema, smoking cessation is paramount, often curative with voice therapy; surgery for advanced cases.

Complications & Red Flags - Danger Signals

• Voice abuse sequelae: Nodules, polyps, Reinke's edema.
• Malignancy: Dysplasia, carcinoma in situ, invasive SCC.
• Red Flags:
  • Hoarseness >3 weeks (esp. smokers)
  • Dysphagia, odynophagia, hemoptysis
  • Weight loss, neck mass, stridor

⭐ Persistent hoarseness >3 weeks in smokers mandates laryngoscopy to exclude malignancy.

High‑Yield Points - ⚡ Biggest Takeaways

• Persistent hoarseness > 3 weeks is the hallmark symptom.
• Key causes: Smoking (most common), LPRD, vocal abuse, chronic infections.
• Reinke's edema ("smoker's larynx"): Diffuse, gelatinous swelling of true vocal cords.
• Laryngitis sicca: Dry, atrophic mucosa with crusting, causing a weak voice.
• Biopsy is crucial to exclude malignancy or dysplasia, especially in smokers or with leukoplakia.
• Management: Voice rest, smoking cessation, humidification, treat underlying cause (e.g., PPIs for LPRD).