Acute Laryngitis: Etiology, Clinical Manifestations, Diagnosis and Treatment

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

Non-infectious factors

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.