Laryngitis - home health advice

Overview
Definition

Laryngitis is an irritation and swelling of the larynx and the surrounding area. It can cause a patient's voice to become hoarse, and possibly to disappear altogether. The condition can take both acute and chronic forms, although the symptoms and treatment are often the same for both types. Acute laryngitis is most common in late fall, winter, and early spring. In general, it resolves within one or two weeks, with or without treatment. The chronic form is often associated with external factors such as smoking and regular exposure to industrial fumes and other allergens. The most common cause in pediatric cases is acute infection, whereas laryngitis in adults tends to have a chronic, noninfectious cause.
Etiology

Both acute and chronic laryngitis are usually caused by a viral infection influenza A, B, parainfluenza, adenovirus, rhinovirus. They can occasionally result from a bacterial infection Streptococcus. Excessive use of the voice, esophageal reflux, irritations, trauma, allergies to inhaled substances, and autoimmune reactions can also lead to the condition. Laryngitis often accompanies colds, and also appears during the course of a variety of other ailments, including bronchitis, pneumonia, influenza, pertussis, measles, and diphtheria.
Risk Factors

* Presence of upper respiratory tract infection
* Chronic bronchitis, rhinitis, sinusitis
* Smoking
* Allergy to and exposure to pollen, dust, and allergens in the workplace
* Alcoholism, or excessive drinking
* Overuse or abuse of voice

Signs and Symptoms

* Unnatural change in the voice
* Hoarseness
* Aphonia
* Tickling, scratchiness, and rawness in the throat
* A constant urge to clear the throat
* Fever, malaise, dysphagia may occur in more severe cases
* Difficulty breathing if the larynx is swollen
* Inflammation of the larynx's lining

Differential Diagnosis

* Gastroesophageal reflux disease
* Diphtheria
* Laryngeal cancer
* Throat cancer
* Vocal cord polyps
* Vocal cord nodules
* Croup
* Thyroid disease

Diagnosis
Physical Examination

Examination of the throat may or may not reveal redness, suggesting the possibility of strep throat. Indirect examination of the larynx may reveal a mild to marked swelling of the organ's mucous membrane. This examination can help to differentiate between laryngitis and diphtheria.
Laboratory Tests

A throat culture will indicate the presence of strep throat or other bacterial infection.
Other Diagnostic Procedures

* Ask patient to describe symptoms completely
* Evaluate the throat and larynx by examination. Fiberoptic or indirect laryngoscopy
* Virus or bacterial culture

Treatment Options
Treatment Strategy

If a bacterial infection has caused the laryngitis, appropriate antibiotics should be prescribed. Laryngitis that results from viral causes has no specific treatment. It can benefit from any one of a variety of relatively unaggressive methodologies, depending on the extent of the condition. Treatment of accompanying acute or chronic bronchitis can improve the laryngitis.

Advise patients to rest their voices for about a week, either by not speaking or by whispering. Patients should also be warned to avoid irritants, such as smoke, cold air, and alcohol. Advise patients to get plenty of rest, increase fluid intake, and consider additional humidification. Such passive treatment presents particular difficulties for children.
Drug Therapies

Antibiotics clear up the bacterial form of laryngitis: 250 mg penicillin or 250 mg erythromycin for 10 to 12 days. Typical medications include broad-spectrum antibiotics such as amoxicillin and tetracycline, taken orally. Antihistamines and inhaled steroids should be prescribed to treat allergies related to laryngitis.
Complementary and Alternative Therapies

Alternative treatments may be effective in cases of acute, chronic, or recurrent laryngitis. Use nutritional support along with lozenges, teas, and an appropriate gargle combination.
Nutrition

* Zinc lozenges (as commercially available): boost the immune system and relieves soreness.
* Vitamin C (1,000 mg tid to qid): needed for proper immune function and to strengthen mucous membranes.
* B-complex (50 to 100 mg/day): enhances immune function, especially during stress.

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, it is important to ascertain a diagnosis before pursuing treatment. Herbs may be used as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, teas should be made with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups/day. Tinctures may be used singly or in combination as noted.

* Slippery elm (Ulmus fulva) soothes irritated tissues and promotes healing.
* Licorice (Glycyrrhiza glabra) has antiviral properties and is soothing to the throat. Licorice is contraindicated in hypertension.

Gargles: Use 5 drops of each tincture listed below in 1/4 cup of water. Gargle and swallow four to six times a day.

* Laryngitis gargle: Coneflower (Echinacea purpurea), sage (Salvia officinalis), and marigold (Calendula officinalis) are soothing and anti-inflammatory herbs.
* Antimicrobial gargle: Coneflower, goldenseal (Hydrastis canadensis), and myrrh (Commiphora molmol) are antibacterial and immune-stimulating herbs.
* Pain relief gargle: Propolis, peppermint (Mentha piperita), and ginger (Zingiber officinalis) are antimicrobial and anodyne herbs.

Homeopathy

An experienced homeopath should assess individual constitutional types and severity of disease to select the correct remedy and potency. For acute prescribing use 3 to 5 pellets of a 12X to 30C remedy every one to four hours until acute symptoms resolve.

* Aconite for laryngitis that comes on after a shock
* Spongia tosta for laryngitis from coughing
* Phosphorus for hoarseness that is painless or with burning pains
* Arum for laryngitis from overuse
* Causticum for hoarseness that comes with every cold and is relieved with cold drinks

Acupuncture

Acupuncture may be helpful in enhancing immune function.
Massage

Therapeutic massage is helpful in reducing the effects of stress.
Other Considerations
Prevention

Avoid abusing or overusing the voice, environmental irritants, and smoking.
Complications/Sequelae

Chronic hoarseness
Prognosis

Laryngitis usually resolves within one to two weeks. Children typically take one week to recover their voices.
Pregnancy

Caution with antibiotics. Goldenseal should be used with caution in pregnancy.
References

Ballenger JJ, Snow JB, eds. Otorhinolaryngology. 15th ed. Philadelphia, Pa: Williams & Wilkins; 1996;30:535-555.

Berkow R, ed. Merck Manual of Diagnosis and Therapy. 16th ed. Rahway, NJ: The Merck Publishing Group; 1992.

Berkow R, Beers MH, Fletcher AJ, eds. Merck Manual, Home Edition. Rahway, NJ: The Merck Publishing Group; 1997.

Hoffman D. The New Holistic Herbal. New York, NY: Barnes & Noble Books; 1995:47.

Larson DE, ed. Mayo Clinic Family Health Book. 2nd ed. New York, NY: William Morrow and Company; 1996.