Chronic laryngitis

What is chronic laryngitis?

Laryngitis is an inflammation of the larynx, the "voice box" that contains the vocal cords in the upper portion of the neck. Laryngitis occurs in two forms, acute and chronic. Acute laryngitis typically is a brief illness producing hoarseness and a sore throat. In most cases, an upper respiratory tract infection causes it. Chronic laryngitis is a more persistent disorder that produces lingering hoarseness and other voice changes. It usually is painless and has no significant sign of infection.

Among adults, the most common causes of chronic laryngitis are:

• Voice abuse or misuse — This means talking too much or too loudly. It can be an ongoing problem for people whose jobs depend on their voices, including singers, actors, telephone operators, lawyers, teachers, referees, coaches and anyone who must shout over loud noise at work (construction workers, personnel in airports and train stations, factory workers). Even children can develop chronic laryngitis from voice overuse or misuse, especially if they shout or strain their voices during choir practice, cheerleading or playground games.
• Smoking — Cigarette smoke irritates the larynx, causing swelling and inflammation that thickens the vocal cords. This thickening can lower the pitch of the voice or make it sound raspy and harsh.
• Drinking alcohol heavily — Alcohol causes a chemical irritation of the larynx that produces changes similar to those seen in smokers.
• Gastroesophageal reflux disease (GERD) — GERD is a disorder in which acidic fluids from the stomach flow backward (reflux) into the esophagus and throat, irritating the larynx. Because acid reflux usually is worse when lying down, the hoarseness caused by GERD often is most noticeable in the morning right after awakening. Although some people with GERD also suffer from heartburn, indigestion and other symptoms related to the digestive tract, these symptoms are often absent in people who have chronic laryngitis because of GERD. Instead, these people may have other complaints involving the nose and throat, such as:
  • the sensation of having a lump in the throat (a symptom called globus)
  • a persistent need to clear the throat
  • discomfort during swallowing
  • persistent cough
• Work-related exposure to irritating chemicals or dusts — Many industrial products are suspected of causing chronic laryngitis and other respiratory problems. The U.S. Department of Labor monitors many of these products and provides safety guidelines for handling and exposure through the Occupational Safety and Health Administration (OSHA).

Less often, chronic laryngitis can be caused by chronic sinusitis with postnasal drip. Rarely, it can be caused by an inflammatory illness or infection directly involving the vocal cords (such as sarcoidosis or tuberculosis).

Symptoms of chronic laryngitis

The most common symptom of chronic laryngitis is hoarseness. For the condition to be truly chronic, this hoarseness must persist for at least two weeks. Depending on the cause of chronic laryngitis, other symptoms can include:

• a low, raspy voice
• a voice that tires easily, "breaks" or "cracks"
• the sensation of a lump in the throat or a dry throat
• a constant urge to clear the throat
• heavy mucus in the throat
• chronic cough or postnasal drip
• discomfort during swallowing.

Diagnosing chronic laryngitis

After reviewing your symptoms, your doctor will ask you about your lifestyle, especially:

• whether you smoke
• whether you drink alcohol, and how much you drink
• whether you engage in activities that require shouting or constant talking
• whether you often are exposed to chemicals or dusts on the job
• whether you have had any recent surgery or trauma to the throat, including surgical procedures in which your vocal cords might have been injured during intubation (putting a tube into your throat to administer anesthesia).

Your doctor will want to know the names of all prescription and nonprescription medications you take because some medications have side effects that can mimic the symptoms of chronic laryngitis. For example, hoarseness due to excessive dryness of the throat can be a side effect of certain antihistamines, cough suppressants, diuretics and psychiatric medications. Decongestants or medications for high blood pressure (hypertension) can cause mucus in the throat to thicken.

Your doctor will examine you, paying special attention to your mouth, throat, nose, ears and the lymph nodes in your neck. Using a special mirror, your doctor will look down your throat and examine your larynx. This exam may be followed by a procedure called laryngoscopy, a more sophisticated method of looking at the larynx using straight or flexible tube-like instruments. If your doctor suspects that you have GERD, additional tests can check for acid reflux in your throat and esophagus.

Expected duration of chronic laryngitis

For laryngitis to be truly chronic, hoarseness must last for at least two weeks. Once chronic laryngitis develops, it is usually a long-term problem in people who continue to smoke, drink alcohol heavily, work with irritating dusts or chemicals, or abuse the voice by shouting or constant talking. Chronic laryngitis caused by GERD will last as long as acid reflux continues.

Preventing chronic laryngitis

You can take these steps to help prevent chronic laryngitis:

• Don't smoke.
• Avoid secondhand smoke.
• Stay well hydrated to help keep your vocal cords moist.
• Avoid alcohol or drink in moderation.
• Use a humidifier to add moisture to the air in your home.
• Avoid long bouts of shouting or uninterrupted talking.
• Take protective measures to limit your exposure to irritating chemicals and dusts.

Treating chronic laryngitis

If your chronic laryngitis is due to smoking, alcohol use, work-related exposures or voice overuse, your doctor will probably recommend that you follow the standard prevention guidelines. In addition, your doctor may refer you to a voice coach or a speech-language pathologist for voice therapy. Voice therapy teaches you to use your voice correctly and to avoid speaking in ways that might injure your vocal cords.

If you have chronic laryngitis due to GERD, your doctor may recommend that you try the following:

• Avoid eating fatty foods, spicy foods and foods that have a high acid content (coffee, orange juice, tomato juice or sauce). This is especially important before bedtime.
• Wait two to three hours after eating before lying down.
• Raise the head of your bed 6 inches. This elevates your larynx above the level of your stomach when you lie down and helps prevent acid reflux.
• Use antacids as recommended by your doctor.

If these strategies do not help, your doctor may prescribe medications to decrease acid production in your stomach.

When to call a professional

Hoarseness that doesn't go away or keeps coming back should never be ignored because it also can be a symptom of certain head and neck cancers. People who drink or smoke heavily are at especially high risk of these cancers. So, if hoarseness lasts more than two weeks, make an appointment to see your doctor. Your doctor may refer you to a specialist (an otolaryngologist, also called an ear, nose and throat doctor) for evaluation and treatment.

Prognosis

If you are willing to make lifestyle changes to treat your chronic laryngitis, the outlook is usually very good. This is especially true for people whose chronic laryngitis is related to smoking, alcohol, work exposure or voice abuse. For people with GERD, a combination of dietary changes and medications to decrease acid production can cure chronic laryngitis in up to two-thirds of cases.

On the other hand, if you have chronic laryngitis and you continue to expose yourself to factors that irritate your larynx, you eventually can develop small nodules or polyps (fingerlike growths) on your vocal cords, which may need to be removed surgically to improve your voice.

Additional info

American Academy of Otolaryngology — Head and Neck Surgery
https://www.entnet.org/

American Speech-Language-Hearing Association (ASHA)
https://www.asha.org/

U.S. Department of Labor's Occupational Safety & Health Administration (OSHA)
https://www.osha.gov/