Chronic Laryngitis: Etiology, Classification, Diagnosis and Treatment

Chronic laryngitis is a group of persistent inflammatory diseases of the larynx (lasting more than 3 weeks) due to prolonged exposure to irritating factors. The forms of the disease differ in etiology (cause) and the nature of pathomorphologic changes in the mucosa – from catarrhal inflammation to hyperplasia or atrophy. Accurate identification of the form determines the treatment tactics and prognosis.

Classification

The major clinical, morphologic, and etiologic forms of chronic laryngitis include:

  • Chronic catarrhal laryngitis is the most common form of chronic inflammation of the larynx, characterized by persistent, moderate inflammation of the mucosa without its atrophy or hypertrophy;
  • Reflux l aryngitis (posterior laryngitis) – inflammation of the mucous membrane of the larynx against the background of gastric contents thrown into the larynx;
  • Atrophic laryngitis is a chronic inflammatory disease of the larynx, which is characterized by thinning and atrophy of the mucosa;
  • Laryngomycosis is a fungal inflammation of the larynx;
  • Chronic hyperplastic laryngitis is a type of chronic laryngitis in which there is an overgrowth of laryngeal tissue.

Chronic catarrhal laryngitis

Etiology of chronic catarrhal laryngitis

Most often the cause of chronic catarrhal laryngitis is smoking, increased vocal stress, allergens. The inflammatory process can spread from the naso- and oropharynx, lower respiratory tract. Recurrent sinusitis, rhinitis, tracheitis, bronchitis can lead to chronic laryngitis.

The following bacteria are found in patients with chronic laryngitis: Staphylococcus aureus, Haemophilus influenza, Candida albicans, Moraxella nonliquefaciens, Neisseria meningitidis, Streptococcus pneumonia, Lactobacillus spp, Helicobacter pylori.

Anatomy of chronic catarrhal laryngitis

The development of chronic laryngitis is the result of a response to irritants.

In chronic catarrhal laryngitis laryngeal epithelium hyperplasia, submucosal edema and catarrh occurs. The mucous membrane becomes smooth and hyperemic Vocal folds are hyperemic, thickened, not fully closed during phonation, mucus in the pear-shaped sinuses.

Clinical picture in chronic catarrhal laryngitis

In chronic catarrhal laryngitis, the leading symptoms are:

  • Hoarseness of the voice, change in its timbre;
  • Rapid voice fatigue;
  • Dry cough;
  • A scratchy throat.

Diagnosis of chronic catarrhal laryngitis

Diagnosis is based on history and clinical examination. Depending on the clinic’s equipment, indirect laryngoscopy or video endoscopy of the larynx is performed.

Treatment of chronic catarrhal laryngitis

The first and most important step in the treatment of catarrhal laryngitis is to identify and eliminate the cause of inflammation. Smoking cessation and reduction of vocal load are recommended.

If the infection spreads from the upper or lower respiratory tract, it is necessary to sanitize the primary focus.

To control inflammation, inhalation with saline solutions, antibacterial drugs, if necessary – glucocorticosteroids are recommended.

Reflux laryngitis

Etiology of reflux laryngitis

In reflux laryngitis, the etiologic factor is insufficiency of the cardia and the throwing of hydrochloric acid and its vapors to the upper respiratory tract.

Anatomy of reflux laryngitis

Reflux laryngitis is characterized by hyperemia and edema in the interscapular space, mucus accumulation in the pear-shaped sinuses.

Clinical picture in reflux laryngitis

Reflux laryngitis is characterized by the following symptoms:

  • A lump in my throat;
  • hoarseness;
  • Pain behind the sternum;
  • Possible heartburn (although this is not a reliable symptom).

The complaints increase at night, during sleep.

Diagnosis of reflux laryngitis

Diagnosis is based on history and clinical examination. Depending on the clinic’s equipment, indirect laryngoscopy or video endoscopy of the larynx is performed. In reflux laryngitis it is necessary to consult a gastroenterologist, perform FGDS and Ph-metry of the esophagus.

Treatment of reflux laryngitis

In case of reflux laryngitis, appropriate treatment is prescribed by a gastroenterologist (reduction of acidity of gastric juice).

To reduce inflammation of the larynx recommend inhalation with saline solutions, antibacterial drugs, if necessary – glucocorticosteroids.

Atrophic laryngitis

Etiology of atrophic laryngitis

Atrophic laryngitis is more common in elderly patients, with hormonal changes (menopause), with prolonged work in harmful conditions (increased dust, harmful chemicals).

Anatomy of atrophic laryngitis

Atrophic laryngitis reduces the number of mucous glands of the larynx. The mucosa acquires the appearance of parchment, is thin, loses its luster, thick viscous mucus is formed on the surface. Vocal folds are also thin, during phonation they close incompletely, forming an oval slit in the center.

Clinical picture of atrophic laryngitis

Atrophic laryngitis is characterized by the following symptoms:

  • Dry, puffy cough, perspiration;
  • Hoarseness of the voice of varying degrees, up to aphonia;
  • The feeling of a lump in your throat.

Diagnosis of atrophic laryngitis

Diagnosis is based on history and clinical examination. Depending on the clinic’s equipment, indirect laryngoscopy or video endoscopy of the larynx is performed.

Treatment of atrophic laryngitis

In atrophic laryngitis it is recommended to constantly moisten the mucosa with saline solutions in the form of inhalations or irrigation with oil solutions. Good effect is observed from irrigation of the mucosa with iodine solutions, when applied, in response to irritation of the mucosa, more mucus is produced.

Laryngomycosis

Etiology of laryngomycosis

In laryngomycosis, the root cause is chronicization of acute fungal laryngitis. It develops in cases of untreated or inappropriately selected therapy of fungi of the genus Candida, Aspergillus, Penicillium. It is more often observed in patients with immunodeficiency or constantly taking inhaled corticosteroids.

Anatomy of laryngomycosis

In fungal laryngitis caused by candida, there are white curd-like deposits on hyperemic mucosa, more often on the epiglottis. In aspergillosis, black colonies are observed on the irritated mucosa.

Clinical picture in laryngomycosis

The following symptoms are noted in laryngomycosis:

  • Difficulty swallowing;
  • Hoarseness of voice;
  • Itchy throat;
  • Bad breath.

Diagnosis of laryngomycosis

Diagnosis is based on history and clinical examination. Depending on the clinic’s equipment, indirect laryngoscopy or video endoscopy of the larynx is performed. A bacteriologic study from the laryngeal mucosa is performed to identify the causative agent and determine sensitivity to drugs.

Treatment of laryngomycosis

To treat fungal laryngitis, topical or systemic antimycotic drugs are prescribed.

To moisturize the laryngeal mucosa, inhalation with saline solutions is recommended.

Chronic hyperplastic laryngitis

This group of diseases includes common hyperplastic laryngitis and chronic edema-polyposis laryngitis (Reinke’s edema). However, a number of authors distinguish Reinke’s edema also into benign laryngeal neoplasms.

Etiology of chronic hyperplastic laryngitis

This group of diseases occurs predominantly in patients in voice professions who use the voice improperly and overstretch it.

It is also common in smokers and alcohol abusers. Less often in persons with harmful production factors (dust, paint solutions, textiles and skin).

Anatomy of chronic hyperplastic laryngitis

Widespread hyperplastic laryngitis is characterized by massive hyperplasia of the laryngeal mucosa, different parts of the larynx thicken symmetrically. More often – the free edge of the vocal folds, the area of the scoop cartilage, the intercarpal space. Due to overgrowths, the laryngeal lumen may be significantly narrowed. The mucosa is hyperemic, bumpy.

In edematous-polyposis laryngitis, bilateral vitreous edema of the entire free edge of the vocal folds is observed. During phonation they do not close completely, the laryngeal lumen may be narrowed due to mucosal overgrowth.

Swelling-polyposis laryngitis
Swelling-polyposis laryngitis – 3D Model

Clinical picture in chronic hyperplastic laryngitis

All diseases in this group are characterized by the following common symptoms:

  • Hoarseness of the voice and changes in its timbre;
  • Prolonged dry cough;
  • The feeling of a lump in your throat.

In severe hyperplasia, aphonia or laryngeal stenosis may develop.

Diagnosis of chronic hyperplastic laryngitis

Diagnosis is based on history and clinical examination. Depending on the clinic’s equipment, indirect laryngoscopy or video endoscopy of the larynx is performed.

3D Animation – Chronic Edematous-Polyposis Laryngitis

An obligatory stage of treatment is biopsy with histologic examination, which is most often performed intraoperatively.

Treatment of chronic hyperplastic laryngitis

Initially, all patients are advised to eliminate causative factors such as smoking and alcohol, increased vocal load, or harmful work environments.

Classes are scheduled with phoniatrists for those in the voice professions.

Treatment is usually combined, consisting of medication and surgical removal.

Conservative therapy includes:

  • Inhalation with isotonic solutions, corticosteroids, if necessary – antiseptic or antibacterial drugs;
  • Intralaryngeal infusions of medications.

Surgical treatment consists of mechanical removal of altered tissues, there are several ways:

  • “Cold” method is the dissection of tissues with microinstruments such as forceps, biters, microdebriders. The advantage of this type is the possibility of obtaining material for histologic study. The disadvantages are the large volume of tissue removed and the possibility of damaging the vocal cord itself, which will lead to irreversible voice disorders.
  • CO2 laser is the “gold standard” of treatment, leaving a minimal wound surface and facilitating rapid recovery. It is recommended to perform after preliminary histological examination of the pathologic tissue (biopsy).

After surgical excision, vocal rest is indicated for best recovery.

FAQ

1. What symptoms are characteristic of chronic laryngitis?

Chronic laryngitis is manifested by hoarseness of the voice, changes in its timbre, rapid voice fatigue, dry cough and throat congestion. With a prolonged course of the disease may develop aphonia, as well as a feeling of a lump in the throat.

2. What could be the cause of chronic laryngitis?

The main cause of chronic laryngitis is smoking, increased vocal load, exposure to allergens and chronic inflammatory diseases of the upper respiratory tract. The disease may also be associated with reflux of gastric contents.

3. What complications can occur with chronic laryngitis?

Chronic laryngitis can lead to complications such as aphonia (loss of voice), laryngeal stenosis, and precancerous lesions if left untreated for long periods of time.

4. What clinical guidelines exist for the treatment of chronic laryngitis?

To treat chronic laryngitis, it is important to stop smoking and reduce vocal load. Regular follow-up with an ENT doctor is recommended, as well as inhalations with saline solutions or corticosteroids. In cases of bacterial infection, antibacterial drugs are used as indicated. For voice professions, training with a phoniatrician is useful.

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