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].

• Hoarseness

  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. [symptoma.com]

  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]

  Though hoarseness may seem like a minor inconvenience, it’s important to avoid the factors that irritate your larynx. [spokesman.com]

  This acid can cause hoarseness and a painful throat (known as pharyngitis. If you are concerned that you may have GERD that is causing a sore throat or hoarseness, you can do a free symptom assessment using the Ada app at any time. [ada.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]

  Chronic Laryngitis Causes The most common causes of chronic laryngitis include: Bad habits that lead to throat irritation (smoking, for example). A prolonged cough due to cold, flu, or another respiratory ailment. [virginiaent.com]

  In the disorder, acidic fluids from the stomach flow backward (reflux) into the esophagus and throat, irritating the larynx. [onlymyhealth.com]

  A person can often treat acute symptoms at home, such as by: avoiding talking, singing, or unnecessary use of the voice drinking plenty of fluids limiting caffeine and alcohol intake avoiding decongestants not smoking avoiding throat irritants, such as [medicalnewstoday.com]

• Laryngeal Disease

  Gastroesophageal reflux and laryngeal disease.. Arch Surg, 128 (1993), pp. 1021-1026 [5] Paterson WG, Murat BW. Combined Ambulatory Esophageal Manometry and Dual-Probe pH-Metry in Evaluation of Patients with Chronic Unexplained Cough.. [bjorl.org.br]

  Procedure preference was determined by the presence of concomitant laryngeal disease and the patient’s ability to tolerate an awake procedure. [ncbi.nlm.nih.gov]

  Very occasionally hoarseness can be attributed to manifestations of laryngeal disease other than tumors (Table 1). [aerzteblatt.de]

• Sighing

  This sensation becomes more prominent during emotional upset and subsides when relaxed Distention and pain in the sides or flanks Suffocating sensation in the chest and hypochondrium Tendency to sigh Melancholy Depression Irritability Inappropriate anger [americandragon.com]

• 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]

• Keratosis

  If no improvement, stripping of the vocal cords by microlaryngoscopy and laser Pathophysiology clinical types of chronic laryngitis Simple diffuse Chronic diffuse Keratosis Contact ulcer Hyperplastic hyperplastic leucoplakia, Larynights larynights squamous [specialist-ent.com]

• Red Urine

  […] cold drinks Excessive appetite: hungry again quickly after eating (as if food vanishes) Swelling, pain, ulceration and bleeding of gums Foul breath Toothache Maybe vomiting right after eating Vomiting acid or undigested food Constipation Maybe scanty, red [americandragon.com]

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.

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