Acute Laryngitis: Etiology, Clinical Manifestations, Diagnosis and Treatment

Acute laryngitis is an inflammation of the larynx that persists for up to 7 days. It is characterized by the development of vascular hyperemia, edema and cellular infiltration of the mucosa, mainly in the area of the vocal folds. These changes impair the function of the vocal apparatus, causing hoarseness, dry cough and a sensation of persistence.

The following forms of acute laryngitis are distinguished:

• Acute catarrhal laryngitis;
• Acute edematous (infiltrative) laryngitis.

Etiology

The causes of acute laryngitis are infectious and non-infectious. Among infectious pathogens, viruses predominate, while bacteria are less common and fungi are extremely rare.

Infectious factors

Non-infectious factors

Anatomic Pathology

Under the influence of an infectious factor, against the background of general body intoxication and catarrhal changes in the nasopharynx and oropharynx, there are similar changes in the mucous membrane of the larynx. If inflammation is caused by a non-infectious cause, pathological changes in the nasopharynx and oropharynx may be absent.

In acute or chronic sinusitis and adenoiditis, mucus flows down the back wall of the pharynx, which gets, among other things, on the vocal folds, causing their mechanical irritation.

Catarrhal form

In the catarrhal form of laryngitis, the mucous membrane is hyperemic, vocal folds are brightly hyperemic, there is abundant injection of blood vessels. During phonation, the vocal folds are not completely closed. There may be mucous discharge on the vocal folds and in the pear-shaped sinuses.

Infiltrative form

In the infiltrative form against the background of hyperemic mucosa of the larynx, a pronounced edema of the mucosa of the vocal folds and interscapular space is determined. They become jelly-like, uneven, when phonation is closed incompletely, the vocal cleft is narrowed. In severe cases, edema may spread to the vestibular folds, which in this case cover the true vocal folds. In some cases, edema spreads to the subclavian mucosa.

Against the background of inflammatory changes in the vocal folds, there is a violation of their vibration. The amplitude and frequency of movement of vocal folds change, which affects vocalization.

Clinical picture

Simple forms of laryngitis (catarrhal, infiltrative) are clinically manifested by a sudden onset of hoarseness in the voice, in some cases – aphonia (loss of voice). Main Symptoms:

• Sore throat, tickling, paroxysms of coughing;
• The voice may become hoarse, tiring quickly;
• Vocal range changes have been observed in individuals in the voice profession.

With the infectious nature of the disease, in addition to localized complaints, the manifestation of other symptoms of respiratory infection is noted:

• Fever;
• Cough;
• Sore throat;
• Nasal breathing disorder;
• Rhinorrhea.

On average, symptoms of acute laryngitis resolve within 1-3 days, but may last up to 7 days.

Diagnosis of acute laryngitis

Diagnostics include:

• Interviewing the patient, collecting the history of the disease;
• Assessment of general condition with mandatory clarification of symptoms of respiratory failure;
• General and otorhinolaryngologic examination;
• Indirect laryngoscopy;
• Laryngeal fibroscopy (if available).

The following changes are observed: hyperemia of the vestibular mucosa, vocal and scoop-anadlaryngeal folds, there is also vascular injection on the vocal folds.

The infiltrative form is characterized by swelling of the vocal folds, which do not close completely during phonation. There may be mucous deposits on the lateral walls of the larynx, between the vocal folds, especially in the area of the interscapular space. The presence of plaque on the vocal folds and other parts of the larynx indicates the bacterial nature of inflammation.

Stroboscopy in patients with laryngitis identifies impaired mobility of the true vocal folds.

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Treatment of acute laryngitis

For most patients with acute uncomplicated laryngitis, symptomatic treatment is sufficient:

• Vocal rest – avoid vocal strain, including whispered speech;
• Smoking restriction;
• Plenty of warm water;
• Humidifying the air and alkaline inhalation – help to improve the condition of the mucous membranes;
• Inhalation with corticosteroids – prescribed in case of severe edema.

In the presence of signs of infection or suspected bacterial nature of the disease prescribe:

• Anti-inflammatory drugs – for symptoms of general infection;
• Topical antibacterial drugs – in the form of sprays if bacterial laryngitis is suspected;
• Systemic antibacterial therapy – in the absence of effect from local treatment.