Acute laryngitis

Laryngitis is an inflammation of the mucous membrane of the voicebox (larynx). It is often accompanied by inflammation of the windpipe (trachea), known as tracheitis.

Laryngitis is almost always caused by a viral infection in the nose and throat region, for example, due to a flu infection.

The inflammation often heals on its own.

What is the larynx and what is its function?

The larynx is located roughly in the middle of the throat and is the point of connection between the pharynx (throat) and the windpipe.

The main function of the larynx is to protect the lower respiratory tract (airways).

The larynx has a type of cover or “lid” (the epiglottis) that can close to prevent food or drink from entering the windpipe.

The larynx also contains the vocal folds (cords), which produce the voice. They allow people to speak and sing.

The most typical symptom of laryngitis is moderate to severe hoarseness and possibly even temporary loss of the voice.

The back of the oral cavity and the throat feel dry and rough. A severe sore throat sometimes also occurs.

Possible additional symptoms include:

• a burning sensation in the throat
• pain when swallowing
• dry cough
• frequent throat-clearing
• breathing difficulties

Some people also feel as though they have a lump in their throat. Voice production, i.e., the production of sounds and tones, further intensifies symptoms and can cause significant stress and strain.

The symptoms often occur suddenly and worsen over several days. The viral infection may cause other accompanying symptoms, such as fever, headache and fatigue.

Symptoms in infants and small children

In infants and young children, laryngitis can cause the larynx to become swollen at the point where it connects to the windpipe. This results in attacks of coughing and wheezing sounds when breathing. This is known as pseudocroup (false croup), meaning an inflammation occurring below the vocal folds.

If laryngitis is accompanied by tracheitis (inflammation of the windpipe), fever, breathlessness and a general sense of feeling unwell will also occur.

Laryngitis is usually caused by a viral infection in the upper respiratory tract, which spreads to the larynx.

In addition, external factors, such as extreme smoke, dust or heat, can cause inflammation of the larynx.

Laryngitis can sometimes also develop as a result of injury, inflammation or diseases of the vocal folds.

Bacteria can also colonize and multiply on the mucous membrane of the larynx.

In rare cases, acute laryngitis is caused exclusively by bacteria. This is the case, for example, with acute inflammation of the epiglottis or diphtheria (also known as true croup).

Laryngitis is more likely to affect people who snore or who have untreated sleep apnea with breathing stopping periodically during sleep.

These individuals are more likely to breathe through the mouth, causing greater drying-out of the mucous membrane in the larynx. This weakens the natural protective barrier and increases the risk of inflammation.

Smoking and excessive use of the voice – for example, in a voice-intensive career as a singer, actor or teacher – can also increase the risk of developing laryngitis.

People with a weakened immune system, for example, because of a chronic health condition, are also more likely to develop laryngitis.

The typical symptoms of acute laryngitis often occur suddenly and worsen over a number of days.

During this period, the tone and volume of the voice are altered, as is the pressure that must be exerted when speaking.

The inflammation can also spread and cause inflammation of other structures, such as the windpipe or throat. Specialists say that the infection has migrated in this case.

People generally recover from the inflammation after two weeks. If it persists for a longer period, the person may have a superinfection – where bacteria colonize the nose and throat region in addition to the viral infection.

If acute laryngitis is suspected, a family doctor is the first port of call.

Diagnosis is based on typical symptoms and on a consultation with the patient, when the doctor takes a detailed medical history. During the consultation, the doctor usually asks about symptoms such as dry cough, loss of voice, pain in the throat/neck and other complaints.

To ensure an accurate diagnosis, it is necessary to have an examination known as a laryngoscopy performed by a specialist in ear, nose and throat medicine or in phoniatrics and pediatric audiology. This procedure involves an internal examination of the larynx, normally using an endoscope.

A laryngoscopy must be performed no later than 4 weeks from the start of persistent hoarseness.

If an additional bacterial infection is suspected, doctors take a swab to enable laboratory detection of the pathogen.

To allow acute laryngitis to heal, it is particularly important to rest the voice and ideally avoid speaking entirely. Doctors refer to this as voice rest.

If people continue to use their voice when they have laryngitis, their recovery from the inflammation may be delayed or incomplete.

What can be done if voice rest is not an option?

If it is not possibly to avoid speaking entirely, people should try to speak in a relaxed manner without using too much pressure. In other words, they should use a relatively quiet and gentle voice.

Further measures

It is important to drink plenty of fluids to lubricate the mucous membrane of the larynx and help flush out the virus. It is also beneficial to avoid stimulants that promote inflammation, such as alcohol and nicotine.

In addition, symptoms may be relieved by cold, damp ambient air or steam inhalation. Steam lubricates the mucous membranes and has a beneficial effect. Thyme, sage or marshmallow can be added to the water for inhalation. Salt water inhalation produces longer-lasting lubrication of the vocal folds. Inhalation devices can be prescribed by families doctors and purchased or rented from pharmacies.

Antibiotics can be used to treat a bacterial infection that occurs alongside laryngitis.