Generality
Laryngitis is the inflammation of the larynx and the vocal cords present in it.
Figure: hoarse voice and sore throat are the typical symptoms of laryngitis
If the associated symptoms last less than three weeks, it is customary to speak of acute laryngitis; if instead they go on beyond, and if the larynx is altered from the anatomical point of view, we speak of chronic laryngitis.
The causes of laryngitis are numerous: the acute form is generally due to viral infections or excessive use of the voice; the chronic form, on the other hand, is usually caused by: cigarette smoking, alcohol abuse, gastroesophageal reflux disease, chronic sinusitis and / or inhalation of irritants.
The main symptoms are hoarseness and sore throat.
Diagnosis and therapy depend on the type and causes. A classic acute virus laryngitis resolves spontaneously within a week; a chronic laryngitis deserves more attention instead.
What is laryngitis?
Laryngitis is the inflammation of the larynx and the vocal cords contained in it.
It is defined as acute when it lasts less than 3 weeks and does not cause any permanent anatomical alteration of the larynx; it is instead defined as chronic when it lasts more than 3 weeks and is associated with permanent anatomical modifications of the laryngeal structures.
Figure: from the site drugs.com
WHAT IS LARINGE?
The larynx is an unequal tube of tubular form, located at the level of the neck before the beginning of the trachea . It represents the last tract of the upper airways (the trachea is in fact considered the first tract of the lower airways) and consists of different cartilaginous structures, held together by a series of muscles and ligaments.
Seat of the vocal cords, the larynx performs three fundamental functions:
- It channels the air towards the trachea, then towards the lungs.
- It allows speech, through the vibration of the vocal cords.
- Thanks to a cartilage valve called epiglottis, it prevents food, which is about to be swallowed, from entering the trachea and obstructing the airways.
Figure: the larynx and the main cartilaginous structures that constitute it are highlighted in red. As can be seen, the larynx is placed at the beginning of the trachea, bordered at the top with the pharynx and is in front of the esophagus, which is the first tract of the digestive canal. From the site: ponsuke2.s98.xrea.com
Figure: the larynx and vocal cords. From the site: ponsuke2.s98.xrea.com
Externally, the larynx can be placed at the so-called Adam's apple (anterior protrusion of the neck more evident in men than in women).
Causes
The causes of laryngitis are numerous.
The acute form can be caused by viral, bacterial or fungal infections, or by excessive use of the vocal cords. The chronic form, on the other hand, is generally due to the inhalation of irritating substances, cigarette smoke, gastroesophageal reflux disease or chronic sinusitis.
In the next two sub-chapters an accurate description is given of all the possible causes that can trigger laryngeal inflammation.
ACUTE LARYNITITE
Acute laryngitis may occur due to:
- Viral type infections . The viral origin is the most common form of laryngitis. The main viruses capable of inflaming the larynx and / or vocal cords are: Rhinoviruses (ie the viruses responsible for most colds), human influenza viruses, human parainfluenza viruses, varicella virus, the virus of mumps, coronaviruses and adenoviruses.
- Bacterial type infections . Acute laryngitis of bacterial origin is much less common than the viral form. The main bacteria potentially capable of causing an acute laryngeal inflammation are: Corynebacterium diphtheriae (the pathogen of diphtheria) and Bordetella pertussis .
- Fungal type infections . The most common fungal infections associated with acute laryngitis are candidiasis and aspergillosis. The first is caused by a fungus of the genus Candida ; the second is induced by a mold of the Aspergillus genus.
The people most at risk of fungal laryngitis are immunosuppressed individuals, people with AIDS and those undergoing chemotherapy or prolonged corticosteroid treatments.
- A vocal effort caused by having shouted a lot or by having used the voice a lot . When screaming for a long time, the vocal cords vibrate faster and for an excessive time, then they become inflamed giving rise to laryngitis.
Laryngitis arising from a vocal effort is also called " mechanical laryngitis ".
Other causes of "mechanical laryngitis":
- Direct trauma to the larynx, for example a blow to the throat occurred during an accident or a sports injury.
- Extended cough
- Frequent clearing of the throat
CHRONIC LARINGITIS
Usually, chronic laryngitis is due to the perpetuation of certain circumstances or the onset of particular morbid states. In detail, it can be triggered by:
- Chronic inhalation (for example for work reasons) of irritating substances, such as chemical fumes, toxic substances, allergens, passive smoke or dust.
- Gastroesophageal reflux disease . It is the ascent, in the esophagus and sometimes up to the throat, of the acid content present inside the stomach.
- Chronic sinusitis . It is an inflammatory state that affects the nasal and paranasal sinuses, characterized by sore throat, headaches, nasal obstruction and nasal discharge.
- Alcohol abuse .
- Cigarette smoke . Large smokers often suffer from chronic laryngitis.
- Profession of singer . Whoever sings by profession can be subject, after years of activity, to a permanent alteration of the larynx and vocal cords.
- Laryngeal cancer .
- Paralysis of the vocal cords . It can be the result of a nerve injury, a neoplasm of the lungs, very strong traumas, surgical interventions (thyroidectomy or column operations) etc.
Furthermore, although rarely compared to the acute form, chronic laryngitis can be caused by some pathogenic microorganisms, such as:
- Bacteria Streptococcus beta haemolytic of group A, Streptococcus pneumoniae, Staphylococcus aureus, Mycobacterium Tuberculosis (the bacterial agent of tuberculosis), Haemophilus influenzae, Klebsiella rhinoscleromatis, Mycobacterium leprae (the bacterium of leprosy), Actinomyces and Treponema pallidum (the bacterium of syphilis ).
- Mushrooms Blastomyces dermatitidis, Histoplasma capsulatum and Sporothrix schenckii .
- The protozoa of the genus Leishmania.
Epidemiology
The precise incidence of laryngitis (both acute and chronic) is unknown; this is because the number of diagnosed cases is undoubtedly less than the number of real cases; moreover, the acute form (usually self-limiting) is more frequent than the chronic.
Regarding the age of greatest onset and the most affected sex, the only reliable datum concerns chronic laryngitis: according to some estimates, the latter would be more common among middle-aged and male people (NB: recently a decrease in the difference between men and women is observed, easily explained by the increased number of smokers).
Symptoms and Complications
To learn more: Symptoms Laryngitis
Usually, the symptoms and signs typical of acute laryngitis appear suddenly and tend to worsen in a short time, within two or three days at the most.
The manifestations of chronic laryngitis, instead, present a gradual onset and slowly worsen over several weeks or months.
MOST COMMON EXPRESSIONS OF LARINGITIS
The most common symptoms of laryngitis are:
- Hoarseness
- Loss of speech or difficulty speaking
- Sore throat
- Dry throat
- Dry and irritating cough
- I still need to clear my throat
- Sensation of itching in the throat
- Slight alteration of body temperature
- Breathing difficulties. They are uncommon in adults and frequent in children, who have a narrower trachea.
WHEN LARIGITES ARE ASSOCIATED WITH OTHER HEALTH DISORDERS
Since laryngitis is often caused by viruses that can also cause colds, flu, tonsillitis or pharyngitis, it is very likely that it will be accompanied by other disorders, such as headache, runny nose, sense of tiredness, generalized joint pain and lymph nodes of the neck enlarged.
DURATION OF SYMPTOMS
Acute laryngitis usually lasts a week, although in some cases it may persist a few more days. Chronic laryngitis, on the other hand, can last a long time, even for several weeks or months .
WHEN TO CONTACT THE DOCTOR?
Most laryngitis heals spontaneously, without the need for special medical treatments or consultations.
If, however, the symptoms last for some time (weeks or months) and are of significant intensity, it is advisable to contact your doctor and request an appointment.
Warning: children with laryngitis who experience respiratory problems are a very delicate and potentially very dangerous situation. Therefore, it is advisable to consult your doctor immediately, describing in detail all the symptoms of the suffering child.
The symptoms that parents and the doctor must arouse in a child are:
- Noisy breath
- Breathing difficulties
- Excessive burr production
- Difficult swallowing
- High fever, even at 39 ° C
Diagnosis
Prolonged and / or severe laryngitis deserves an in-depth analysis: this is why it is essential for the doctor to submit the patient to a thorough physical examination and to specific diagnostic tests, such as checks on a blood sample and a pharyngeal swab, laryngoscopy and biopsy of the larynx.
EXAMINATION OBJECTIVE
During the physical examination, the doctor analyzes the entire symptom picture and clarifies the patient's personal medical history (ascertaining the health conditions at the time of diagnosis, the illnesses suffered in the past, any allergies, etc.).
Furthermore, it is essential that the doctor establishes whether he is dealing with a smoker, a person who abuses alcohol, a person with chronic sinusitis, a professional singer or a worker in some industrial plant (the aforementioned circumstances being all potentially determinant in a context of laryngitis).
BLOOD TESTS AND FARINGEO BUFFER
The doctor uses blood tests and a throat swab to determine if the patient suffers from some kind of infectious disease.
In both cases, these are quick, economic and potentially able to provide various information useful for diagnostic purposes.
LARYNGOSCOPY
Laryngoscopy is the diagnostic test that allows you to assess the health of the larynx and vocal cords. There are two types of laryngoscopy: indirect and direct.
- Indirect laryngoscopy . Turned into the doctor's surgery, it is a very simple procedure, which requires the use of two objects: a small mirror, to be inserted in the patient's throat, and a light source, with which to illuminate the mirror and see the larynx reflexively. Usually, it does not foresee any anesthesia; however, if the patient under examination is bothered by the presence of the mirror, it may be useful to practice local anesthesia.
Compared to indirect laryngoscopy, direct laryngoscopy is much more precise and, if performed with the rigid laryngoscope, it also allows the collection of a sample of laryngeal tissue for a possible bioptic examination.
LIOINGE BIOPSY: WHAT IS IT AND WHEN IS IT PRACTICE?
The larynx biopsy consists of the collection, and subsequent microscopic analysis, of a sample of laryngeal tissue. It is usually performed when a malignant tumor of the larynx is suspected (or wants to make sure that it is not in progress).
The collection procedure takes place by direct laryngoscopy with a rigid laryngoscope.
Other tests useful in case of suspected laryngeal malignancy:
- CT scan (or computerized axial tomography) : it is a very precise diagnostic imaging test, which however exposes the patient to a minimal amount of ionizing radiation.
- Nuclear magnetic resonance (RMN) : it is a reliable and completely harmless imaging diagnostic test.
ALLERGIC TESTS
If there is a suspicion that laryngitis is caused by an allergy to some volatile substances (dust, chemical fumes, etc.) or to certain foods, the doctor will surely prescribe allergy tests.
WHAT SPECIALIST IS IT BETTER TO CONTACT?
Often, when a primary care physician finds chronic and / or severe laryngitis, he advises the patient to consult an otolaryngologist, or a doctor who specializes in treating ear, nose and mouth diseases.
Treatment
For further information: Drugs for the treatment of laryngitis
Most laryngitis heals within 7 days and without special care. Nevertheless, for an even more rapid and effective resolution of disorders, doctors advise to put into practice certain remedies and / or countermeasures (such as drinking plenty of water, avoiding talking too much, etc.).
If the laryngitis is chronic, the situation is more complex and delicate: in fact, to heal, the doctor needs to plan a specific therapy, based on the triggering causes.
REMEDY TO ACCELERATE HEALING
To accelerate healing and alleviate symptoms caused by laryngitis, it is very useful:
- Avoid talking too much and too loudly . Shouting or talking a lot ignites the vocal cords; therefore, if the latter are already inflamed, it is not advisable to solicit them further.
- Take plenty of fluids, especially water, to avoid getting dehydrated. Alcoholic beverages and coffee should be avoided until complete resolution of symptoms.
- Wash with mouthwash or water and salt based solutions . Although these substances do not reach the larynx directly, they are nevertheless very effective in keeping the throat moist and reducing the inflammatory state.
- Take anti-inflammatory and pain-relieving drugs, such as paracetamol, ibuprofen or aspirin . Such medicines are appropriate when the patient complains of an annoying throat pain, headache, fever etc. (therefore the symptoms of a flu or a strong cold).
- Make hot-humid or menthol-based inhalations, to release the respiratory tract and lungs from the mucus. Still with the same goals, doctors also recommend hot showers and the use of a portable air humidifier in the rooms where you spend most of your time.
- Do not smoke (if you are a smoker), avoid breathing passive smoke and do not go to dusty and dry environments.
MAIN TREATMENTS FOR CHRONIC LANGUAGES
If at the origin of chronic laryngitis there is:
- A bacterial infection requires antibiotic therapy.
- Excessive alcohol consumption or cigarette smoking, it is good to stop drinking (or at least drastically moderate alcohol intake) and smoking.
- Gastroesophageal reflux disease, take the most appropriate medicines for this type of disorder (antacid drugs); these preparations consist of substances that decrease the acidity of gastric secretions.
- An allergy, we must avoid coming into contact with responsible substances (so-called allergens) and obtain antihistamine drugs for emergencies (for example, when we inadvertently ingest a food to which we are allergic or when we inhale a powder towards which one is intolerant).
- A professional use of the voice, it is appropriate to learn and regularly practice some targeted vocal exercises, which allow to safeguard the vocal cords and the larynx in general.
- A cancer of the larynx, the malignant tumor must be removed and / or treated with laser, radiotherapy and chemotherapy.
WHEN TO USE CORTICOSTEROIDS?
Corticosteroids are powerful anti-inflammatory drugs, which, when used in excessive doses and for long periods of time, can cause serious side effects.
Main side effects of corticosteroids:
- Osteoporosis
- Glaucoma
- Hypertension
- Overweight and obesity
- Gastric ulcers
In the case of laryngitis, their intake is considered by the attending physician only if the symptoms are very intense and the situation is quite critical.
It is strongly advised against taking them without a prescription.
Prevention
Preventing laryngitis is possible, as long as: you pay attention to your personal hygiene (it is good practice to always wash your hands after using the bathroom, to avoid the spread of bacterial infections); avoid frequenting people who are temporarily suffering from flu or cold; avoid dusty environments; wear appropriate masks if you are dealing with toxic chemicals; do not smoke; moderate alcohol intake; sleep with a pillow behind your head to avoid acid reflux from your stomach; take care of your voice; your throat is not constantly cleared.
Prognosis
In general, acute laryngitis has a positive prognosis. For chronic forms, on the other hand, the prognosis depends on how serious the causes are.
