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Laryngitis in Adult
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Laryngitis in Adult

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Contributors: Madeline Goosmann, Paul C. Bryson MD
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Synopsis

Laryngitis is inflammation of the larynx causing hoarseness of voice. It may have an acute presentation, typically caused by upper respiratory infection or phonotraumatic behaviors, or a chronic presentation lasting over 3 weeks. Chronic causes include prolonged phonotrauma, repeated exposure to inhaled irritants including smoking, chronic sinusitis with postnasal drip, chronic alcohol use disorder, laryngopharyngeal reflux, or chronic coughing.

Patients typically present with the following symptoms:
  • Hoarseness, dysphonia
  • Globus sensation
  • Throat clearing
  • Voice change
  • Pharyngitis
  • Postnasal drip
  • Dry cough
  • Dry throat
  • Dysphagia
Signs such as edema and hemorrhage may be present in patients with vocal cord trauma. Other known etiologies for laryngitis include infection, caustic / toxic ingestion, and inhalation.

Chronic laryngitis can present similarly to malignancy, so it is important to rule this out when clinical suspicion is present. While the prevalence of acute laryngitis is difficult to estimate with lack of reporting and conservative treatment measures, the annual incidence of chronic laryngitis is estimated to be 3.47 per 1000 people.

Infectious diseases to consider are croup, epiglottitis, diphtheria, pertussis, laryngeal tuberculosis, syphilis, leprosy, actinomycosis, candidiasis, blastomycosis, coccidioidomycosis, and histoplasmosis. Geographic and travel history can be useful in differentiating fungal infections.

Immunocompromised Patient Considerations:
Immunocompromised individuals are at particular risk for infectious laryngitis, particularly invasive fungal infection.

Codes

ICD10CM:
J04.0 – Acute laryngitis

SNOMEDCT:
45913009 – Laryngitis

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Rhinitis – Nasal discharge, with or without allergies, associated with sneezing, itching, and congestion.
  • Psychogenic dysphonia – Look for comorbid psychological conditions.
  • Spasmodic dysphonia – Usually has a strained / tight-sounding voice with breaks.
  • Laryngeal malignancy – Risk factors include smoking and alcohol use disorder.
  • Upper respiratory infection – Expect to see other symptoms such as cough, congestion, and fever that begin to resolve in a week.
  • Chondronecrosis – Presents with hoarseness and breathiness, usually with a history of radiation exposure or trauma.
  • Vocal fold cysts, polyps, nodules – Not always due to overuse or misuse; look for hoarseness and pitch changes, especially in those with occupations that require speaking.
  • Laryngeal papillomatosis – Can cause airway obstruction and hoarseness in pediatric patients; typically presents as hoarseness in adults.
  • Sulcus vocalis – Congenital or traumatic vocal cord defect that is the manifestation of loss of vocal cord pliability, usually with history of injury, surgery, or infection.
  • Vocal cord paralysis – Immobility of vocal folds due to neurogenic injury from surgery, malignancy, or idiopathic causes that produces hoarseness, conversational dyspnea, and vocal fatigue, and sometimes airway obstruction with shortness of breath if bilateral.
  • Epiglottitis – Thumbprint sign on lateral x-ray; have low threshold for intubation; check vaccinations.
  • Postintubation trauma – Seen when large endotracheal tubes are used or in prolonged intensive care unit (ICU) intubations.
  • Subglottic stenosis – History of trauma or intubation.
  • Glottic stenosis – History of trauma or intubation.
  • Croup – Predominately seen in children; check for steeple sign on chest x-ray, barking cough, and hoarseness.

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Reviewed: 09/06/2019
Last Updated: 09/06/2019
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Laryngitis in Adult
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Laryngitis : Cigarette smoking, Hoarseness, Non-productive cough, Voice change, Globus sensation, Dysphagia, Sore throat
Copyright © 2020 VisualDx®. All rights reserved.