Acute Sinusitis (Acute Rhinosinusitis): Classification, Clinical Manifestations, Diagnosis, and Treatment
A detailed review of rhinosinusitis, including classification, symptoms, diagnostic approaches, and current treatment strategies.
Acute Laryngitis: Etiology, Clinical Manifestations, Diagnosis and Treatment
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Acute laryngitis is inflammation of the larynx that may persist for up to 7 days. The condition is characterized by vascular hyperemia, edema, and cellular infiltration of the mucosa, primarily within the vocal cords. These alterations impair the glottic function, leading to dysphonia, dry cough, and a tickling sensation.
Acute laryngitis may be classified as follows:
- Acute catarrhal laryngitis;
- Acute edematous (infiltrative) laryngitis.
Etiology
Acute laryngitis may be either infectious or noninfectious. Infectious agents are primarily viral; bacterial causes are less common, and fungal etiologies are extremely rare.
Infectious factors
| Viruses | Influenza, Parainfluenza, RSV, Adenoviruses, Rhinovirus, Coxsackie virus, Coronavirus, Measles |
| Bacteria | Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis |
| Fungi (more common in chronic laryngitis) | Candida, Aspergillus, Penicillium |
| Inflammatory processes of the upper respiratory tract | Adenoiditis, sinusitis, rhinitis |
Non-infectious factors
| Allergic reactions | Dust, animal dander, chemicals |
| Excessive vocal strain | Singing, shouting, prolonged speaking, improper voice use |
| Irritating environmental factors | Smoke, chemical fumes, polluted air |
Anatomy
Under the influence of an infectious factor and general body intoxication, similar changes occur in the laryngeal mucosa as in the nasopharynx and oropharynx. In noninfectious causes, pathological changes in the nasopharynx and oropharynx may be absent.
In cases of acute or chronic sinusitis and adenoiditis, mucus drips along the posterior pharyngeal wall. This mucus can also fall onto the vocal cords, causing mechanical irritation.
Catarrhal form
In catarrhal laryngitis, the mucosa appears inflamed, and the vocal folds are markedly hyperemic with abundant vascular injection. Phonation is impaired due to incomplete closure of the vocal folds. Additionally, mucous secretions may accumulate on the vocal folds and within the piriform sinuses.
Infiltrative form
In the infiltrative form, hyperemic laryngeal mucosa is accompanied by pronounced edema of the vocal folds and interarytenoid region. The vocal folds become gelatinous and irregular, failing to achieve complete closure during phonation. As a result, the rima glottidis appears narrowed. In severe cases, the edema may involve the vestibular folds, which overlie the true vocal cords, and extend to the subglottic area.
Inflammation of the vocal folds may also interfere with their vibratory function. Changes in amplitude and frequency affect phonation.
Clinical Manifestations
Simple forms of laryngitis (catarrhal, infiltrative) present with sudden hoarseness, and in some cases, aphonia (loss of voice).
Main symptoms:
- Sore throat, tickling, paroxysmal cough;
- The voice becomes hoarse and fatigues quickly;
- Individuals in vocal professions experience changes in vocal range.
In infectious conditions with local signs, patients may present additional respiratory infection symptoms, such as:
- Fever;
- cough;
- Throat pain;
- difficulties breathing through the nose;
- rhinorrhea.
On average, symptoms of acute laryngitis resolve within 1 to 3 days, but may persist for up to 7 days.
Diagnosis of Acute Laryngitis
Diagnosis includes:
- Patient interview, acquisition of disease history;
- Evaluation of overall condition with obligatory specification of respiratory insufficiency symptoms;
- General and otolaryngological examination;
- Indirect laryngoscopy;
- Laryngeal fibroscopy (if feasible).
The following changes are observed: mucosal hyperemia of the vestibular region, vocal folds, and aryepiglottic folds. Vascular injection is also observed on the vocal folds.
Infiltrative laryngitis is associated with edema of the vocal folds, resulting in incomplete glottic closure during phonation. Mucosal accumulations may be observed along the lateral walls of the larynx and between the vocal folds, particularly in the interarytenoid region. The presence of plaque on the vocal folds or other laryngeal structures may indicate bacterial inflammation.
Stroboscopic examination in patients with laryngitis typically reveals impaired mobility of the true vocal folds.
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Treatment of Acute Laryngitis
For most patients with uncomplicated acute laryngitis, symptomatic treatment is sufficient:
- Voice rest — avoid vocal strain, including whispering;
- Limitation of smoking;
- Plentiful warm drinks;
- Air humidification and alkaline inhalations — help to improve mucosa condition;
- Inhalations with corticosteroids — indicated for pronounced edema.
If an infection or bacterial etiology is suspected, the following treatments are recommended:
- Anti-inflammatory medications — for alleviating symptoms of systemic infection;
- Topical antibacterial agents — administered as sprays in suspected cases of bacterial laryngitis;
- Systemic antibiotic therapy — indicated if topical treatment has proven ineffective.
FAQ
1. What are the symptoms of acute laryngitis?
Acute laryngitis presents with sudden hoarseness, paroxysmal coughing, sore throat, tickling sensations, and, in some cases, complete loss of voice (aphonia).
2. What are the symptoms of acute laryngitis in children, and how is it treated?
In children, acute laryngitis typically manifests as hoarseness, dry cough, and breathing difficulties, which may be due to swelling of the vocal cords. Treatment usually involves humidifying the air, voice rest, and generous intake of warm fluids. In some instances, inhalation therapy and anti-inflammatory medications may be prescribed.
3. What are the primary causes of acute laryngitis?
Acute laryngitis may arise from both infectious (viral and bacterial) and non-infectious causes. Viruses, such as influenza, parainfluenza, RSV, and others, are the primary pathogens. Exposure to allergens, excessive vocal strain, air pollution, and irritating chemicals may also contribute.
4. What are the clinical recommendations for acute laryngitis?
Symptomatic treatment is recommended, including air humidification, inhalation of alkaline mineral water, and plenty of warm fluids. If a bacterial infection is suspected, antibacterial medications may be prescribed. In cases of pronounced edema, inhaled corticosteroids may be indicated. Voice rest is essential, particularly avoiding whispering, and smoking cessation is strongly advised.
5. How long does acute laryngitis last?
Acute laryngitis typically lasts for 1–3 days; however, symptoms may persist for up to 7 days, especially when the condition is caused by infection or if complications have developed.
References
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VOKA 3D Anatomy & Pathology – Complete Anatomy and Pathology 3D Atlas. VOKA 3D Anatomy & Pathology.
Available from: https://catalog.voka.io/
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Sclafani AP, Dyleski RA, Pitman MJ, Schantz SP. Total otolaryngology—head and neck surgery. New York: Thieme Medical Publishers; 2015. ISBN: 978-1-60406-646-3.
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Behrbohm H, Kaschke O, Nawka T, Swift A. Ear, Nose, and Throat Diseases. 2nd ed. Moscow: MEDpress-inform; 2016. 776 p. [In Russian.] ISBN 978-5-00030-322-1.
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Gupta G, Mahajan K. Acute Laryngitis. [Updated 2022 Sep 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-.
Available from: https://www.ncbi.nlm.nih.gov/books/NBK534871/
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Jaworek AJ, Earasi K, Lyons KM, Daggumati S, Hu A, Sataloff RT. Acute infectious laryngitis: A case series. Ear Nose Throat J. 2018 Sep;97(9):306-313. doi: 10.1177/014556131809700920. PMID: 30273430.
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