Laryngitis: Causes, Treatment and Prevention

Laryngitis is an inflammation of the larynx, the medical term for the voice box. Your vocal cords are two thin, pliable bands of muscle located in your voice box. Healthy vocal cords open and close when you use your voice, creating vibrations that produce sound, but the tissues can become irritated or inflamed with overuse or infection.

Laryngitis is the most common of laryngeal conditions. It can be acute, meaning it can occur suddenly, and it only lasts for a few days. Acute laryngitis often resolves spontaneously, as many people would know from having a cold or mild allergies. Chronic laryngitis can cause symptoms that last for more than three or four weeks and can be a sign of a vocal cord injury or a growth on the vocal cords. Chronic laryngitis can indicate a more serious medical condition and may require diagnosis and treatment from a specialist.

Laryngitis Symptoms

Common laryngitis symptoms include:

• Hoarse voice
• Voice loss
• Sore or dry throat
• Sensation of something lodged in the throat or needing to frequently clear the throat
• Dry cough
• Throat pain

It should be noted that these symptoms can overlap with symptoms of COVID-19, allergies and sinus issues. If you have persistent symptoms for four weeks or more, you should make an appointment with an otolaryngologist, also known as an ear, nose and throat specialist.

Causes of Laryngitis

Acute cases of laryngitis are often caused by irritants to the vocal cords, such as a minor infection. Laryngitis can also be caused by:

• Overusing your voice
• Yelling or screaming
• Vocal fatigue
• Sinusitis (infection in the sinuses)
• Smoking
• Heavy drinking
• Reflux
• Allergies
• Preexisting respiratory conditions such as asthma

Laryngitis affects women and men of all ages, but certain people are more prone to laryngitis than others because of the way they use their voice or the anatomy of their voice box. Ear, nose and throat specialists often use the concept of a “voice bank” to explain vocal overuse to patients. An individual can safely make a certain number of “withdrawals” each day without causing damage to vocal quality. If you have a hoarse voice or you lose your voice by the end of the day, you may be damaging your vocal cords.

Most people do not reach the point of overuse, but people who use their voice often and loudly, such as teachers, pastors, singers and actors, have the highest risk for laryngitis. However, due to the COVID-19 pandemic, ear, nose and throat specialists are seeing an increase in people with vocal issues who aren’t typical patients. More people than ever before are working from home and meeting virtually, which can lead to increased vocal strain.

“People use their voices differently when they are speaking to each other in person versus when they are speaking through a screen,” said Jonathan Bock, MD, FACS, otolaryngologist. “During a virtual meeting, you don’t realize how much harder you work to project your voice in order to be heard and how this can inadvertently strain your vocal cords.”

Diagnosis

Your ear, nose and throat appointment should include a detailed history of your voice use and concerns related to your throat and your ability to swallow. The ear, nose and throat specialist will also do a physical exam, which consists of a full head and neck exam with a direct examination of the voice box tissues to look for the potential cause of your voice issue.

The physician uses numbing spray in your nose to make it easier to pass a thin flexible tube with a camera and light attached to it through your nose and into your throat. This part of the exam takes about two minutes and is called a videostroboscopy. It allows the physician to observe the structure of your vocal cords and how they vibrate, as well as to identify any stiffness in the vocal tissue and any physical abnormalities of the vocal cords.

Small lesions and nodules on the undersurface of the vocal cords are often hard to see, but videostroboscopy provides a full view of the cords vibrating in slow motion. It allows physicians to assess vocal cord closure and vibration and make the most accurate diagnosis.

How to Get Your Voice Back at Home

Acute cases of laryngitis generally go away on their own after a week or two. These self-care tips can help you get your voice back.

• Drink lots of fluids to stay hydrated.
• Rest your voice by speaking as little and as quietly as possible.
• Avoid whispering because it may put more strain on your voice than speaking.
• Avoid irritants like caffeine or tobacco smoke.
• Avoid decongestant medications because they can dry out or lead to irritation in your throat.
• Consider using a personal humidifier to make it easier for you to inhale and swallow.

If you’re suffering from symptoms that do not resolve in that timeframe, talk to your doctor about medications that might speed up recovery. Antibiotics are not typically prescribed for laryngitis because acute cases are usually the result of viral, not bacterial infections. In certain cases, corticosteroids may be prescribed to reduce inflammation.

Laryngitis Treatment

The Froedtert & MCW Vocal Health Program team has experience with routine concerns and complex medical conditions. The team is also active in national clinical research to improve care and outcomes for patients with vocal health conditions.

Many Froedtert & MCW voice and swallowing disorder specialists also have first-hand knowledge of vocal health problems because they have backgrounds in the performing arts.

Vocal therapy can be an effective treatment for people dealing with chronic laryngitis. People who sing or speak with incorrect technique or who overuse their voice can develop calluses on the vocal cords, often called vocal nodules. Vocal therapy with a speech therapy pathologist helps reeducate the vocal muscles and change behaviors and vocal patterns that result in injury to the vocal cords.

In many cases, chronic laryngitis can be permanently resolved with conservative measures. When vocal therapy does not help, microlaryngeal surgery, a minimally invasive procedure to remove vocal cord lesions, may be a treatment option. This is a one hour surgery, and you can go home the same day after a short recovery period. During the surgery, your physician uses a microscope to look directly at your vocal cords in the operating room. With this enhanced view, your doctor can remove vocal cord lesions that may be causing chronic laryngitis. They can also inject medications like steroids directly into the vocal cords to reduce swelling and inflammation.

Voice Rest

Voice rest can be helpful for acute cases of laryngitis, when your vocal cords are swollen and need a few days to recover. Discomfort and swelling should resolve within 24-48 hours of starting voice rest. Long-term voice rest is not recommended, except for patients recovering from vocal cord surgery.

“There is no indication for voice rest for more than a week after even the most aggressive laryngeal surgeries,” Dr. Bock said. “Studies show patients recovering from surgery can benefit from voice rest for a period of five to seven days, when the healing process begins. Any longer, and there is no benefit. However, we do know that if we make the vocal cords vibrate correctly, the healing process can be accelerated.”

If you have been advised to go on long-term voice rest, Dr. Bock recommends getting a second opinion.

Preventing Laryngitis

The best way to prevent laryngitis and keep your vocal cords healthy is to listen to your body and be aware of the first signs of vocal fatigue. These include a hoarse voice, tightness in your neck muscles or feeling like you can’t speak for as long as you’re used to or at your usual volume.

For virtual meetings, headphones with a built-in microphone can help minimize the risk of straining your vocal cords. If your profession requires you to use your voice a lot or consistently project your voice at high volume, try using a voice amplification system.