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Chronic Laryngitis

Chronic laryngitis is a condition characterized by laryngeal inflammation lasting for longer than six weeks. It leads to waxing and waning dysphonia and hoarseness of voice and may be a precursor to laryngeal cancer. Vocal abuse, smoking, laryngopharyngeal reflux, and allergies are some of the causes of chronic laryngitis.


Presentation

Chronic laryngitis (CL) is chronic laryngeal inflammation with an annual incidence of about 4 cases per population of 1000 [1]. The most common cause of CL is laryngopharyngeal reflux but other causes include vocal abuse (singing, teaching), smoking, excessive alcohol and caffeine intake, bacterial and fungal infections as well as occupations like glass blowing [2] [3] [4].

Patients usually present with waxing and waning dysphonia, globus (foreign body) sensation in the throat, pain in the throat, constant urge to clear the throat, and dry cough. Symptoms of dysphonia include reduced volume, hoarseness, raw sensation, inability to modulate the voice and vocal fatigue.The symptoms depend on the severity of the inflammation. In severe infections, patients may have a fever, laryngeal edema, dyspnea and even stridor. Chronic laryngeal mucosal injury secondary to gastroduodenal reflux (GERD) of acidic contents has been implicated as a cause of CL in almost 50% of the patients [5]. Clinical features of CL associated with GERD are called laryngopharyngeal reflux (LPR) as the main region affected is the laryngopharynx [6] [7].

Abdominal Obesity
  • Women with abdominal obesity were also at higher risk for chronic laryngitis (OR 1.475, 95% CI 1.024-2.126). CONCLUSION: Obese women in Korea have an elevated risk for developing chronic laryngitis.[ncbi.nlm.nih.gov]
Constitutional Symptom
  • We report a 49 years old non-smoker, non-diabetic, immunocompetent man presenting with chronic dry cough and hoarseness without any constitutional symptoms, family or contact history of TB. The chest X-ray was normal.[scopemed.org]
Hoarseness
  • Abstract In order to study a possible role of Helicobacter pylori infection in chronic laryngitis, we performed endoscopic and histological assessments in addition to a urease test for the bacterium in 35 patients with chronic hoarseness.[ncbi.nlm.nih.gov]
  • Though hoarseness may seem like a minor inconvenience, it’s important to avoid the factors that irritate your larynx.[askdoctork.com]
  • Herpes simplex viral infection of the vocal cords should be considered in patients with acquired immunodeficiency syndrome presenting with chronic hoarseness and leukoplakic lesions on direct laryngoscopy, especially with no evidence of Kaposi's sarcoma[ncbi.nlm.nih.gov]
  • Throat discomfort and pain upon emitting sounds There is often a habit of clearing ones throat but no evident sputum is coughed up The hoarseness is more evident when attempting to make a high pitched sound A long history of hoarseness and aphonia Hoarseness[americandragon.com]
Sputum
  • […] expectorated Small amounts of difficult to expectorate sputum Blood tinged sputum (when Yin Deficiency Fire is present) Afternoon fever Night sweats Malar flush (especially in afternoon) Five sole Heat Dry mouth and throat Itching in throat Hoarse voice[americandragon.com]
  • If infective etiology is suspected then a complete blood cell count, erythrocyte sedimentation rate with sputum cultures and sensitivities for bacteria, fungi, and viruses should be ordered.[symptoma.com]
  • Diagnosis Laboratory studies in chronic laryngitis include the following: Complete blood cell count with differential if an infection is suspected Sputum cultures and sensitivities for bacteria, fungi, and viruses Swab of the laryngeal mucosa, culture[emedicine.medscape.com]
  • Typical symptoms include hoarseness, rarely aphonia (see), sometimes a cough with little sputum. The General condition is almost not affected.[medicalency.com]
  • The hematogenous route and the infected sputum from pulmonary tuberculosis are the most likely sources of infection.[emedicine.medscape.com]
Throat Irritation
  • Chronic throat irritation 4. Dry hacking cough Signs: 1. Vocal cord edges loose their pearly shine and appear red and congested with dilated blood vessels on the superior surface. 2. Cord movements appear asynchronous and flabby on phonation 3.[specialist-ent.com]
  • Gastroesophageal reflux disease (GERD): Stomach acids flow backward (reflux) into the esophagus and throat, irritating the vocal cords. Work-related exposure to chemicals or dusts that irritate the vocal cords.[askdoctork.com]
  • In the disorder, acidic fluids from the stomach flow backward (reflux) into the esophagus and throat, irritating the larynx.[onlymyhealth.com]
  • Allergies —whether to pets, pollen, or peanuts—can lead to throat irritation and inflammation, which could result in laryngitis, Comer says.[prevention.com]
Laryngeal Disorder
  • (disorder), chronic; laryngitis, laryngitis; chronic, Chronic laryngitis, NOS, Chronic Laryngitis Dutch laryngitis chronisch, chronische laryngitis, laryngitis chronisch NAO, chronisch; laryngitis, laryngitis; chronisch, Chronische laryngitis French[fpnotebook.com]
Dysphagia
  • The most common symptoms were dysphonia (53%), pain/soreness (45%), globus sensation (40%), cough (33%), excessive throat clearing (28%), and dysphagia (32%). An otolaryngologist saw 93% of the cases.[ncbi.nlm.nih.gov]
  • Dysphagia. Globus pharyngeus (feeling of a lump in the throat). Continual throat clearing. Myalgia. Fever. Fatigue and malaise.[patient.info]
Small Hand
  • The small hand-spray atomizer may be used, though better results follow the use of the steam or compressed-air atomizer.[henriettes-herb.com]

Workup

The diagnosis of CL is based on clinical evaluation and patient history. It is vital for the otolaryngologist to inquire about the patient's occupation, allergies, vocal abuse and infections (tuberculosis). During the physical examination, an indirect, as well as, flexible nasopharyngolaryngoscopy is performed in all patients presenting with dysphonia lasting longer than 3 weeks. LPR can be diagnosed on the basis of the presenting symptoms and the appearance of laryngeal edema and arytenoid erythema on laryngoscopy [8]. In addition, thick, sticky mucus may be noticed in the piriform sinuses and valleculae. A video-stroboscopy provides information about vocal fold anatomy, vibratory pattern and can help to differentiate between a sulcus vocalis from mucosal stiffness. If infective etiology is suspected then a complete blood cell count, erythrocyte sedimentation rate with sputum cultures and sensitivities for bacteria, fungi, and viruses should be ordered. Serology for autoimmune disorders like sarcoidosis should also be considered. Skin allergy testing is recommended if an allergic etiology is suspected. Barium swallow, manometry and 24 hour pH monitoring are recommended for the diagnosis of GERD.
Although plain X-ray neck has no role in the diagnosis of CL, plain X-ray chest may help to detect pulmonary tuberculosis or sarcoidosis as the cause of CL. Computed tomographic scan and magnetic resonance scan are not routinely performed but may help to detect soft tissue changes, structural laryngeal changes, as well as, tumors.
Microlaryngoscopy under general anesthesia to visualize the larynx with a microscope may be necessary to detect tiny lesions and obtain tissue for biopsy, as well as for staining and cultures. The histological examination may reveal pachydermia (in long-term smoker's CL), amyloidosis, granulomatous lesions as well as malignancies. Lipoid proteinosis with hyaline deposits can mimic chronic laryngitis [9] on histology.

Treatment

  • All patients received treatment with pantoprazole 80 mg daily for 8 weeks. One week after the end treatment, patients had a second ENT examination and a 24-hour pH monitoring using dual-channel probe. We included 33 patients (11 men, 22 women).[ncbi.nlm.nih.gov]
  • The symptoms of 34 of the remaining 41 patients responded to treatment with omeprazole 20 mg at bedtime. Therefore, symptoms of 96% of patients responded to treatment aimed at preventing reflux of gastric acid.[ncbi.nlm.nih.gov]
  • Weak tension of vocal cords was often seen in these patients and persisted after the 8-week-long treatment.[ncbi.nlm.nih.gov]
  • This may confound the diagnosis of chronic laryngitis and delay treatment. Conversely, a positive study during comprehensive therapy may help identify patients who need additional treatment.[ncbi.nlm.nih.gov]
  • The role of pH testing and most common errors in treatment are reviewed.[ncbi.nlm.nih.gov]

Prognosis

  • Before anti-tubercular drug use, in the 1950’s, it was a common and frequently fatal disease but it’s clinical features, age group involved and prognosis has changed over the last few decades.[scopemed.org]
  • The prognosis in confirmed laryngitis is not favorable, as but few have the patience necessary to persist in the use of remedies until a cure is effected.[henriettes-herb.com]
  • Rarely, in severe infections such as those with herpes viruses, laryngeal erosion and necrosis may occur. [ 1 ] Prognosis In acute laryngitis, the prognosis is usually excellent.[patient.info]
  • Laryngitis Prognosis Chronic laryngitis is a concern. If the a person has a change in his or her voice, or hoarseness that lasts more than 2 to 3 weeks, a doctor should be consulted.[emedicinehealth.com]

Etiology

  • These findings show a possible role of H. pylori infection in the etiology of chronic laryngitis in certain patients and can be important for clinical diagnosis and treatment.[ncbi.nlm.nih.gov]
  • Skin allergy testing is recommended if an allergic etiology is suspected. Barium swallow, manometry and 24 hour pH monitoring are recommended for the diagnosis of GERD.[symptoma.com]
  • However, the prevalence of CL and role of air pollution in the etiology is uncertain.[ncbi.nlm.nih.gov]
  • Amitriptyline is commonly used for mental/mood problems, but is also prescribed to treat chronic laryngitis because some investigators suggest a neuropathic etiology for idiopathic chronic laryngitis.[clinicaltrials.gov]
  • But, “its causes commonly are not recognized or are misdiagnosed because of lack of familiarity with some of the etiologies and suboptimal physical examination.”[enttoday.org]

Epidemiology

  • Further epidemiological and experimental studies are necessary to clarify the impact of obesity on this condition. 2015 S. Karger GmbH, Freiburg.[ncbi.nlm.nih.gov]
  • Further epidemiological and experimental studies are necessary to clarify the impact of chronic PM10 exposure on CL.[ncbi.nlm.nih.gov]
  • Epidemiology. 12:200–208. pmid:11246581 View Article PubMed/NCBI Google Scholar 24.[journals.plos.org]
  • Key words Laryngitis insulin resistance epidemiology Republic of Korea This is a preview of subscription content, log in to check access. References 1. Hammer HF.[link.springer.com]
  • Response rate to mailed epidemiologic questionnaires: A population-based randomized trial of variations in design and mailing routines . Am J Epidemiol 1998; 147 : 74–82.[nature.com]
Sex distribution
Age distribution

Pathophysiology

  • Pathophysiology : Dilated vessels are seen on superior surface of vocal cords. Movements are flabby and sluggish. Interstitial oedema and inflammatory exudates are present.[specialist-ent.com]
  • World journal of gastrointestinal pathophysiology. 2010;1:91–96. CrossRef PubMed PubMedCentral Google Scholar 21. El-Serag HB, Graham DY, Satia JA, Rabeneck L. Obesity is an independent risk factor for GERD symptoms and erosive esophagitis.[link.springer.com]
  • Signs and symptoms of laryngitis that last weeks or months and that may vary in severity over this period of time, are rarely caused by infectious or mechanical pathophysiological processes.[journals.plos.org]
  • The basic pathophysiology is inflammation of the mucosa lining the vocal folds and larynx. If infection is involved, white cells aggregate to remove infectious material from the area.[patient.info]

Prevention

  • By having a good comfort level in your throat you will be able to prevent your voice or throat from straining and therefore can prevent inflammation.[onlymyhealth.com]
  • Therefore, symptoms of 96% of patients responded to treatment aimed at preventing reflux of gastric acid. The remaining patients with refractory symptoms had a partial response or no response or chose fundoplication.[ncbi.nlm.nih.gov]
  • Biofilm has an important role in finding new preventive measures and treatment of these diseases.[ncbi.nlm.nih.gov]
  • For prevention of a disease it is necessary to strengthen immunity, to limit the use of spicy, fat, salty food, not to abuse alcohol and to refuse smoking.[herbalthera.com]
  • Preventing chronic laryngitis Prevention can be achieved by treatment of a gastric reflux condition, avoidance of smoking and smoke exposure, and moderate use of the voice.[ada.com]

References

Article

  1. Stein DJ, Noordzij JP. Incidence of chronic laryngitis. Ann Otol Rhinol Laryngol. 2013;122:771-774.
  2. Baletic N, Jakovljevic B, Marmut Z, Petrovic Z, Paunovic K. Chronic laryngitis in glassblowers. Ind Health. 2005;43:302-307.
  3. Chen H, Thornley P. Laryngeal tuberculosis: a case of a non-healing laryngeal lesion. Australas Med J. 2012;5:175-177.
  4. Allen CT, Merati AL. Acute and chronic laryngitis; in Flint PW, Haughey BH, Lund VJ, Niparko JK, Robbins KT, Thomas JR, Lesperance MM (eds). Cummings Otolaryngology Head & Neck Surgery. Philadelphia, Mosby Elsevier, 2015, pp 928-935.
  5. Koufman JA. The otolaryngologic manifestations of gastroesophageal reflux disease (GERD): a clinical investigation of 225 patients using ambulatory 24-hour pH monitoring and an experimental investigation of the role of acid and pepsin in the development of laryngeal injury. Laryngoscope. 1991;101:1-78.
  6. Koufman JA. Laryngopharyngeal reflux is different from classic gastroesophageal reflux disease. Ear Nose Throat J. 2002;81:7-9.
  7. Koufman JA, Aviv JE, Casiano RR, Shaw GY. Laryngopharyngeal reflux: position statement of the Committee on Speech, Voice, and Swallowing Disorders of the American Academy of Otolaryngology-Head and Neck Surgery. Otolaryngol Head neck Surg. 2002 Jul;127 910: 32- 5
  8. Farrokhi F, Vaezi MF. Laryngeal disorders in patients with gastroesophageal reflux disease. Minerva Gastroenterol Dietol. 2007;53:181-187.
  9. Oz F, Kalekoglu N, Karakullukçu B, Oztürk O, Oz B. Lipoid proteinosis of the larynx. J Laryngol Otol. 2002 Sep; 116(9):736-9

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Last updated: 2018-06-22 05:53