Laryngitis
Laryngitis is an inflammation of the voice box called larynx. It is unusual to have a laryngitis separately from the upper respiratory infections. Upper respiratory infections (URIs) are infections of the mouth, nose, throat, larynx (voice box), and trachea (windpipe).
In this article:
- Treatment
- Acute laryngitis (croup) treatment
- Acute allergic laryngitis treatment
- Chronic laryngitis treatment
- Medical treatments
- Surgical treatment
- Lifestyle and home remedies
- References
Treatment
Treatment is dependent on the cause of the laryngitis.
- Infectious laryngitis or croup
Most of the cases are mild and resolving without specific treatment within 5-7 days. Sometimes barky cough persists for 1-2 weeks longer. It is frequently triggered with voice strain and laughter.
In the very young children laryngitis frequently is a sign of an RSV infection that may rapidly develop into laryngotracheobronchitis (LTB), with an urgent need for medical intervention. Many babies with LTB are hospitalized due to severe breathing problems and dehydration.
Acute laryngitis (croup) treatment
Croup leads to signs of upper airway obstruction, and must be differentiated from acute epiglottitis, bacterial tracheitis, or an inhaled foreign body. Croup affects about 3% of children per year, usually between the ages of 6 months and 3 years, and 75% of infections are caused by parainfluenza virus. Symptoms usually resolve within 48 hours, but severe upper airway obstruction can, rarely, lead to respiratory failure and arrest.
- Oxygen is standard treatment in children with respiratory distress.
- A single oral dose of dexamethasone improves symptoms in children with mild croup, compared with placebo.
- Although humidification is often used in children with mild to moderate croup, we found no RCT evidence to support its use in clinical practice.
- In children with moderate to severe croup, intramuscular or oral dexamethasone, nebulized adrenaline (epinephrine), and nebulized budesonide reduce symptoms compared with placebo.
- Oral dexamethasone is as effective cure as nebulized budesonide at reducing symptoms, and is less distressing for the child.
- A dexamethasone dose of 0.15 mg/kg may be as effective as a dose of 0.6 mg/kg. Adding nebulized budesonide to oral dexamethasone does not seem to improve efficacy compared with either drug alone.
Acute allergic laryngitis treatment
Allergic laryngitis that develops as a part of systemic allergic reaction (anaphylaxis) requires immediate treatment with self-injecting devise containing life-saving medication epinephrine. Frequently, even if laryngitis resolved, a person needs to be brought to the ER or nearest urgent clinic to be checked and observed for a second wave of the reaction. While epinephrine is the first and upmost important treatment, other measures such as steroids, intravenous fluids and oxygen will be needed to control symptoms of anaphylaxis.
Milder symptoms can be treated at home with antihistamines and allergy avoidance measures. It is important to establish the cause of the allergic reaction. An Allergist will determine the problem with an allergy skin test and lab tests.
Chronic laryngitis treatment
Chronic laryngitis may be due to many reasons. It may take some time and many visits to different specialists to figure out what causes it. Once the reason for chronic hoarseness is established, a treatment course will show an improvement. A speech therapy may be recommended if the chronic laryngitis is caused by voice strain and overuse. Allergy measures should be taken and immunotherapy started if the chronic laryngitis is caused by the dust mite or other indoor allergy.
Medical treatments
Medical treatments of the laryngitis depend on the cause of the inflammation of the larynx and vocal cords. Medications are given as needed to control symptoms and swelling of the airways. As laryngitis is very rarely caused by the bacteria, most patients do not need antibiotics. The pain control is important, as crying in children will cause worsening of the symptoms.
Severe situations require hospital admissions and intensive care management. In this case, medications are used to support breathing and good oxygenation and to be able that life functions are supported.
Surgical treatment
Surgical treatment need is extremely rare, but if needed it is done to ensure a person can breathe. It includes:
- Tracheotomy
- Intubation and artificial airway
It is important to establish independent breathing and remove the artificial airways as soon as possible in a person with laryngitis. Acute laryngeal injury occurs in more than half of patients who receive mechanical ventilation and is associated with significantly worse breathing and voicing 10 weeks after extubation. An endotracheal tube greater than size 7.0, diabetes, and larger body habitus may predispose to injury. Acute laryngeal injury impacts functional recovery from critical illness, and can lead to a permanent voice change with hoarseness.
Lifestyle and home remedies
There are some very effective home remedies that help treat laryngitis in children:
- Essential oils. Eucalyptus, lavender and chamomile oils used in a diffuser may help soothe the throat and vocal cords. Do not use them if there are allergies
- Moist air. Steaming up the bathroom works great – just run all the faucets and hold your child in your arms. Run humidifier in the bedroom next to the head side of the bed
- Eat soft food, avoid spicy or hot recipes.
- Avoid allergens in food. Take care of the environmental allergy (do allergy shots or sublingual drops SLIT)
Laryngitis in adults will respond to similar measures. In addition, it is important to take care of other possible causes, such as allergy, voice overuse and GERD.
Vocal cords are affected if there is a significant acid reflux, especially during night. As a matter of fact, hoarseness might be the only presentation of the “silent” GERD. Here are measures you can easily do at home:
- Lose weight if you are overweight
- Eat early dinners. Undigested food in the stomach will cause acid to be produced while you sleep
- Reduce amount of alcohol, do not drink it late at night
- Adjust your mattress and pillow to lift your head and neck slightly
- Eat healthy organic food
- Exercise daily
References
Efficacy of acid suppression therapy in gastroesophageal reflux disease-related chronic laryngitis. Yang Y, Wu H, Zhou J.Medicine (Baltimore). 2016 Oct;95(40):e4868. doi: 10.1097/MD.0000000000004868.PMID: 27749540 Free PMC article. Review.
Laryngitis and aerosols. Stollard GE.Br Med J. 1970 Feb 28;1(5695):568. doi: 10.1136/bmj.1.5695.568.PMID: 5435212 Free PMC article.
Hoarseness-causes and treatments. Reiter R, Hoffmann TK, Pickhard A, Brosch S.Dtsch Arztebl Int. 2015 May 8;112(19):329-37. doi: 10.3238/arztebl.2015.0329.PMID: 26043420 Free PMC article. Review.
Antibiotics for acute laryngitis in adults. Reveiz L, Cardona AF.Cochrane Database Syst Rev. 2015 May 23;2015(5):CD004783. doi: 10.1002/14651858.CD004783.pub5.PMID: 26002823 Free PMC article.
Allergic laryngitis: chronic laryngitis and allergic sensitization. Campagnolo A, Benninger MS.Braz J Otorhinolaryngol. 2019 May-Jun;85(3):263-266. doi: 10.1016/j.bjorl.2019.02.001. Epub 2019 Mar 4.PMID: 30898484 Free article. Review.