Laryngitis: What Is, Causes, Symptoms, Treatment, and Prevention

Inflamed vocal cords, on the other hand, get swollen, which causes their surface to be uneven and makes air get distorted when passing through them, which, as a result, causes hoarseness.

Acute laryngitis usually goes away on its own within 1-2 weeks. It is considered chronic (long-lasting) laryngitis if it persists for over three weeks.

Larynx – General Information

The larynx is a part of the upper respiratory tract between the pharynx and the trachea (windpipe). It is a tube about 4-5 centimeters long that lets the air pass through it to the trachea so it can reach the lungs. Since the larynx contains voice cords, its other function is making a voice, which is why it is sometimes called a voice box.

The larynx is divided into three sections:

• Supralarynx – the upper part
• Larynx – the middle section
• Sublarynx – the lower part

The larynx is built out of nine cartilages connected by ligaments and muscles. Thyroid cartilage, one of the larynx cartilages, is commonly known as Adam’s apple. The entries to the larynx and esophagus are near each other. The elastic cartilage called epiglottis closes the entry to the larynx to prevent the food from entering the respiratory tract when swallowing.

The middle part of the larynx contains voice cords. During voice production, the vocal cords vibrate transversely to each other, opening and closing, which interrupts the airflow. It is the vibration of air waves that produces sound.

The pitch of the sound depends on the vocal cords’ tension, length, and thickness. The larynx of children and women produces higher sounds than the larynx of men because it has shorter vocal cords.

The loudness of the voice depends on the strength of the air current and the amplitude of the vibrations of the vocal cords. In voiceless whispering, the vocal function of the larynx is inactive.

Causes

Several factors may cause laryngitis. Causes slightly differ depending on whether it’s an acute or chronic condition.

Acute laryngitis is most often caused by:

• Voice trauma from singing, yelling, or talking for a long time. This commonly happens to coaches or fans.
• Viral infection – Some of the usual cold-causing bugs are the rhinovirus, the flu, RSV, coronavirus, and adenovirus. For grown-ups, the main reason they might get laryngitis is because of these viruses. When kids get a harsh, barking cough, it could be called croup, usually caused by the parainfluenza virus.
• Bacterial infection – Certain germs can cause your larynx to get inflamed, including ones with names like Streptococcus pneumoniae and Haemophilus influenzae.
• Fungal infection causes laryngitis extremely rarely in people with weak immune systems.

Chronic laryngitis causes include:

• Long-term voice overuse
• Allergies – pollen and other inhalation allergens can irritate the surface of the larynx.
• Smoking – inhaling harmful substances contained in cigarettes causes edema to the voice cords and irritates the larynx.
• Gastroesophageal reflux disease (GERD) – in GERD, the stomach’s acidic contents flow back to the esophagus and throat. It can reach the larynx and vocal cords, irritating it and causing symptoms of laryngitis.
• Environmental pollution – environmental factors may irritate the vocal cords and trigger larynx inflammation.
• Asthma – people with asthma use inhalers with medications that may lead to larynx irritation.

Is Laryngitis Contagious?

Laryngitis might spread to others from a germ like a virus, bacteria, or fungus. But, if it happens because of allergies, smoking, strong chemicals, stomach acid, or shouting too much, then it’s not something that you can catch from someone else.

How Common Is It?

Around one in five individuals might experience chronic laryngitis at some point. While this condition can affect anyone, adults are more often affected than kids. It affects men and women in similar proportions. It rarely happens to children under three, and when it does, the doctors usually look more thoroughly at the child’s condition as it may suggest a more severe problem.

Symptoms

The symptoms that may appear during laryngitis include:

• Hoarseness – in chronic larynx inflammation, hoarseness usually starts in the morning and gradually gets better during the day
• Loss of voice
• Grunting, frequent need to clear the throat
• Throat pain and discomfort, especially while talking
• Dry cough that doesn’t go away
• Tickling in your throat
• A feeling of throat dryness
• Barking cough – acute laryngitis in children (croup) often presents with a characteristic cough that resembles a dog barking, hence the name – barking cough.
• Fever – if viruses or bacteria cause laryngitis, high body temperature may accompany it
• Swallowing problems – if this symptom appears, you should contact your doctor for more thorough diagnostics
• Excessive drooling

Small children may also show symptoms such as:

• Not eating or drinking
• Difficulty breathing (rarely)

Symptoms of acute laryngitis most often appear suddenly and increase in intensity quickly. In the case of chronic laryngitis, the symptoms develop gradually and may initially be overlooked by the patient.

Uncomplicated laryngitis lasts about ten days and typically goes away on its own.

Laryngitis In Children

Larynx inflammation sometimes also happens to children. However, it presents differently than in adults. The child’s larynx is smaller than a grownup’s and is higher. That’s why the edema and symptoms of breathing difficulties appear faster in children.

Croup is a unique form of acute laryngitis in children that usually affects children between 1 and 5 years old. It is typically caused by viruses and usually starts with flu-like symptoms (runny nose, fever). After a few days, a barking cough, breathing difficulties, hoarseness, and stridor (a high, rough sound resulting from impaired airflow through narrowed airways) develop. Symptoms typically get worse at night and get better when breathing cold air.

In most cases, croup isn’t life-threatening. However, you should seek emergency medical attention in case of extreme symptoms, especially severe shortness of breath.

Risk Factors

Some people have a higher risk of getting laryngitis than others. Risk factors include:

• Having chronic respiratory infections (sinusitis, bronchitis, or pharyngitis)
• Exposure to chemical inhalants
• Smoking or living with a smoker
• Excessive drinking
• Using asthma medications such as steroid inhalers frequently
• Having gastroesophageal reflux disease (GERD)
• Overusing your voice (being a coach, speaker, teacher, singer, or fan)
• Having allergies, especially to pollens
• Having a weak immune system
• Not being vaccinated against Haemophilus influenzae type b (in the United States, this vaccination is recommended to all children under five years old as this bacteria can cause serious illness in small children)

Diagnosis

Your healthcare provider will probably recognize laryngitis based on characteristic symptoms, such as hoarseness, dry cough, and voice problems. Acute laryngitis typically doesn’t require tests as it is easy for doctors to recognize based only on presenting symptoms. If your symptoms persist for a more extended period or are especially alarming, your doctor may look into your medical history in search of possible factors that trigger inflammation. The doctor may examine your voice cords, and you may be referred to an ear, nose, and throat specialist for further diagnostics.

If necessary, your doctor may use the following techniques to determine if you have laryngitis and how bad it is:

• Taking a culture sample – to find which germ is causing your symptoms, your healthcare provider examines your throat and then swabs it. Next, the swab is taken to the laboratory, where the germs grow.
• Laryngoscopy involves inserting a flexible tube with a camera into the back of your throat through the mouth or nose. During this procedure, the doctor can visually examine your larynx. Sometimes, doctors can investigate visually vocal cords using a small mirror and a light.
• Biopsy – When a suspicious spot is found during a laryngoscopy, the doctor takes a sample, which is later examined under a microscope.

Treatment

If left untreated, laryngitis usually goes away within ten days. In some cases, your doctor may prescribe you medications to make the recovery process quicker or if your symptoms are severe.

Medications

Depending on the cause of the inflammation, various medications can be used:

• Antibiotics – Most laryngitis cases are viral infections, meaning antibiotics won’t help. However, if the disease is caused by bacteria or bacterial superinfection occurs, the doctor prescribes antibiotics.
• Corticosteroids – In some cases, corticosteroids are necessary to reduce edema and inflammation of the larynx and vocal cords. Corticosteroids are used in children with croup who have developed breathing difficulties.
• Antifungals – used in rare cases of larynx inflammation caused by fungus (yeast infection)
• Painkillers – OTC painkillers, such as ibuprofen and paracetamol, may help relieve pain and discomfort during a disease.

Self Care

For most people with laryngitis, the disease goes away on its own. Here are some self-care tips you can use during laryngitis to relieve symptoms and reduce voice strain:

• Drink lots of fluids to avoid getting dehydrated
• Avoid smoking as it additionally irritates the larynx and makes the condition worse
• Rest your voice – you should avoid talking, shouting, or singing when having larynx inflammation
• Use a humidifier to moisturize the air you breathe. It helps to reduce dry throat symptoms.
• Avoid alcohol
• Keep your throat moist – honey, gargling salt water, herbal teas, and sucking on throat lozenges might help with that.
• Avoid taking decongestants, as these medications tend to dry out your throat.
• Don’t whisper – whispering strains your voice even more than talking, so try to avoid it.

How To Distinguish Laryngitis From Pharyngitis?

Although the throat and larynx are very close, the inflammation of these organs is different. Pharyngitis is a term that refers to the inflammation of the pharynx, commonly known as a sore throat. Laryngitis is often confused with pharyngitis because the same pathogens can cause both diseases and initially cause similar symptoms. However, laryngitis is a much more dangerous disease that can quickly escalate to life-threatening shortness of breath. It is distinguished from pharyngitis primarily by a characteristic barking cough but also by problems with speaking and breathing.

Complications

Usually, laryngitis is caused by non-infectious factors or viruses and passes without complications. However, bacterial superinfection may be the reason if the infection doesn’t disappear after ten days.

One of the complications is further developing the infection and involvement of the lower respiratory tract, Inflammation of the trachea, bronchi, or lungs, and permanent dysfunction of the vocal cords. In some situations, untreated long-term laryngitis may cause the development of cancer.

Prevention

Laryngitis can be contagious and may have a complicated course, especially in the youngest children. Therefore, the best solution is to avoid getting sick. This is not always possible, but appropriate prevention can reduce the risk.

Supporting your immune system and taking care of your voice is vital. Properly humidified air in rooms, frequent ventilation, reasonable use of air conditioning, and quitting smoking are worth keeping in mind. People working in conditions exposing them to vapors of irritating substances should pay special attention to proper respiratory protection to limit the inhalation of harmful substances.

To keep your voice box and vocal cords healthy, especially if your job requires you to talk or sing a lot, experts say it’s crucial not to yell or whisper too much. Staying hydrated helps prevent voice box swelling, too. So, it’s best to steer clear of smoking and anything that dries out your throat and voice box.

When Should You See a Doctor?

Typically, laryngitis goes away on its own by staying hydrated and resting the voice. However, if you notice the following symptoms, seek emergency medical help:

• Breathing difficulties
• Coughing up blood
• If the symptoms are particularly severe or keep getting worse
• The fever doesn’t go away after painkillers
• Your child makes a high-pitched sound while breathing (stridor)
• Your child has trouble swallowing
• Symptoms of laryngitis concern an infant

If symptoms persist for over two weeks, you should see a doctor, even if your symptoms are mild. In the case of long-term laryngitis, the cause needs to be identified. In more challenging or complicated cases of larynx inflammation, the ear, nose, and throat specialist is the one who treats it.

Sources

• National Cancer Institute (NIH) Larynx & Trachea https://training.seer.cancer.gov/anatomy/respiratory/passages/larynx.html
• National Library of Medicine (NIH) Gunjan Gupta; Kunal Mahajan. Acute Laryngitis (2022) https://www.ncbi.nlm.nih.gov/books/NBK534871/
• Stein DJ, Noordzij JP. Incidence of chronic laryngitis. Ann Otol Rhinol Laryngol. 2013 Dec;122(12):771-4. doi: 10.1177/000348941312201207. PMID: 24592580. https://pubmed.ncbi.nlm.nih.gov/24592580/
• National Health Service (NHS) Laryngitis (2024) https://www.nhs.uk/conditions/laryngitis/
• Siebert JN, Salomon C, Taddeo I, Gervaix A, Combescure C, Lacroix L. Outdoor Cold Air Versus Room Temperature Exposure for Croup Symptoms: A Randomized Controlled Trial. Pediatrics. 2023 Sep 1;152(3):e2023061365. doi: 10.1542/peds.2023-061365. PMID: 37525974. https://pubmed.ncbi.nlm.nih.gov/37525974/
• Centers for Disease Control and Prevention (CDC) Hib (Haemophilus influenzae type b) Vaccination (2021) https://www.cdc.gov/vaccines/vpd/hib/index.html
• National Library of Medicine (NIH) Omeed Sizar; Barbara Carr. Croup (2023) https://www.ncbi.nlm.nih.gov/books/NBK431070/
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