When your voice vanishes
Almost all of us have experienced laryngitis, a temporary hoarseness or loss of voice caused by minor inflammation of the larynx (voice box and vocal chords) and its surrounding tissues. Laryngitis is inconvenient and can be uncomfortable, but it's rarely serious. Laryngitis is most common when there are epidemics of individual viruses going around, especially during late fall, winter, and early spring.
Most cases of laryngitis are caused by viral infections that begin as colds or sore throats and then travel down to the voice box, irritating the vocal cords and surrounding tissues. In young children, a similar infection can produce croup, along with its characteristic "barking" cough, or a more serious respiratory blockage called epiglottitis, swelling of the epiglottis, the thin flap covering the larynx.
Fortunately, most common cases of laryngitis can be safely treated at home. Cases of viral laryngitis should disappear spontaneously within 10 to 14 days.
The most obvious symptom of laryngitis is a hoarse voice; in more severe cases, you may temporarily lose your voice completely. You may also get a dry cough and a sore throat. There may be some pain with swallowing, and very rarely there can be difficulty swallowing or breathing.
In rare cases, laryngitis may be accompanied by a fever or may be unusually painful. In these cases, consult a doctor.
Laryngitis usually lasts less than two weeks. Simple remedies, including resting the voice and drinking plenty of fluids can speed your recovery. However, continued misuse of the voice may cause the development of vocal cord nodules, small growths on the vocal chords, that can permanently distort the voice.
By far the most common cause of laryngitis is a simple viral infection like the common cold of the upper respiratory pathways. Other medical causes include bronchitis, pneumonia, influenza, whooping cough (pertussis), measles, and diphtheria. Excessive use of your voice, allergic reactions, and inhaling irritants such as cigarette smoke are common causes of either acute (short-term) or chronic (persistent) laryngitis.
The body parts involved include both the larynx the voice box containing the vocal cords and the upper part of the neck behind the Adam's apple. In most cases, the first and most noticeable symptom of laryngitis is an unnatural change of voice, such as hoarseness, or even a total loss of voice. The throat may feel raw or tickle. Symptoms vary with the severity of the inflammation. Severe infections may result in fever, general malaise, and a sore throat.
Bacterial infections like strep throat, and irritation from alcohol or toxic vapors, dust and smoke, and even hot beverages can cause laryngitis. Hay fever and other allergies can also cause vocal changes, including hoarseness or loss of voice. Screaming and yelling extensively can stress the vocal cords and sometimes lead to problems such as inflammation of the larynx and the growth of nodules that may endanger the vocal cords. Without treatment, these nodules may cause permanent voice distortion.
Despite the inconvenience of losing your voice, and the discomfort of hoarseness and a sore or dry throat, most cases of laryngitis can be effectively treated on an outpatient basis without doctor visits. General measures to reduce discomfort for both acute and chronic cases include resting the voice, using cool mist humidifiers and steam inhalations, increasing fluid intake, and, sometimes, using analgesics. Always avoid smoking or secondhand cigarette smoke while you have laryngitis. Anyone with a hoarse voice that lasts longer than a week or two should seek medical advice.
How Common Is Laryngitis?
Laryngitis is a common condition affecting males and females equally. Laryngitis affects all ages, although it is more common in children.
Goals of Treatment
Your doctor's treatment goals are to eliminate pain, to restore your voice, and to clear up any infection that may be present.
Spontaneous recovery from viral laryngitis usually occurs within 10 to 14 days. Check with your doctor if you do not see any improvement within this time frame.
Symptoms can be treated at home in several ways. The most important thing to keep in mind is that you must rest your voice completely to reduce stress on your vocal cords. Drink fluids and chew sugarless gum to help keep you vocal chords moist. Whispering is also very stressful on the vocal cords. If you use your voice intensively (for example, if you are a teacher or a singer) you must stop work to rest your voice and stay at home.
If laryngitis is caused by a bacterial infection, your doctor will prescribe antibiotics. Viral laryngitis doesn't respond to these drugs and is self-limiting. Nevertheless, you can alleviate the uncomfortable symptoms of laryngitis while waiting for recovery.
Home care is generally the most effective treatment. Rest your voice, use a vaporizer, and increase your fluid intake. Warm liquids may be especially soothing.
Health Care Professionals Who May Be Involved in Treatment
The following health care providers participate in the management of laryngitis:
- Family medicine physicians
- Ear, nose, and throat specialists
|Drugs most commonly prescribed|
Most cases of laryngitis are not severe and do not require surgery. In extreme cases, a surgeon may recommend vocal-cord stripping of hyperplastic mucosa and areas of leukoplakia.
Monitoring the Condition
Nonprescription drugs like acetaminophen, aspirin, and cough syrup may be appropriate and useful. Don't use your voice; give it complete rest. A cool-mist humidifier will increase air moisture and ease the constricted feeling in the throat. Hot, steamy showers may help as well. Avoid cold pills that contain antihistamines, as they may dry out your throat and increase hoarseness. Stay well-hydrated; drink six to eight eight-ounce glasses of water a day.
Consult a doctor if the laryngitis is accompanied by a fever or becomes acutely painful. If laryngitis lasts more than two weeks, be sure to call your doctor. With children, call the doctor immediately if your child feels very ill, has a high fever, or has difficulty breathing.
Possible complications associated with laryngitis include the following:
- Chronic hoarseness
- Total breathing obstruction: may occur if laryngitis is part of a serious infection of the respiratory system; with children, epiglottitis may cause the epiglottis to swell and make breathing difficult
Quality of Life
For the most part, laryngitis will not alter your quality of life, so don't feel compelled to limit activity unless you are feeling especially tired. To help the healing process, avoid talking.
Considerations for Women
Pregnant women should only use antibiotics that will not harm the developing fetus.
Considerations for Children and Adolescents
Minimize a child's vocal activities. Discourage your child from shouting, crying, or singing, since these activities will only delay recovery.
Considerations for Older People
Consider these if you are an elderly patient or caring for one:
- Since the immune system functions less effectively as people age, this may open the way for viral, bacterial, and other infections to occur
- Decreased nutrition, common among older people, can increase the risk of laryngitis
- With aging, characteristic signs and symptoms of many disorders are frequently changed or may be absent
Last updated 27 May 2012
- Acute laryngitis
- Chronic laryngitis
Laryngitis has numerous established causes:
- Viral infections: influenza type A or B, parainfluenza, adenovirus, coronavirus, rhinovirus (the common cold), human papillomavirus (HPV), cytomegalovirus (CMV), herpes simplex virus (HSV)
- Bacterial infections: beta-hemolytic streptococcus, Streptococcus pneumonia, H. influenza, tuberculosis, leprosy, Moraxella catarrhalis, diphtheria
- Excessive use of voice
- Inhaling irritating substances
- Breathing caustic chemicals
- Aging changes: muscle atrophy, loss of moisture in larynx, bowing of vocal cords
- Fungal infections
General risk factors for acute (short-term) laryngitis include:
- Exposure to airborne irritants (mold, dust, and pollutants) and extremely cold weather
- Recent respiratory illness
Specific risk factors for acute laryngitis include:
- Persistent overuse of the voice
Risk factors for chronic laryngitis include:
- Chronic sinusitis
- Voice abuse
- Alcohol abuse
- Constant exposure to dust or other irritants
Risk factors are traits or behaviors that may make you statistically more likely than others in the general population to have a certain condition. They do not necessarily causes laryngitis.
Symptoms & Diagnosis
The diverse symptoms of laryngitis include:
- Hoarseness or loss of voice
- Sore throat or tickling in the back of the throat
- High-pitched, trembling, weak voice
- Sensation of a lump in the throat
- Constant urge to clear the throat
- Swallowing difficulty (rare)
- Slight fever (with associated upper respiratory infection)
- Regional lymphadenopathy (inflammation of the lymph nodes)
- Stridor (high-pitched breathing) in children
Conditions That May Be Mistaken for Laryngitis
Laryngitis may be confused with several other conditions, including the following:
- Vocal nodules
- Laryngeal cancer
- Thyroid malignancy
- Lung cancer
How Laryngitis Is Diagnosed
In the vast majority of cases, laryngitis will be diagnosed based on the history you describe. If symptoms persist and the condition becomes chronic, your doctor will check you voice box and vocal cords for inflammation, using a laryngoscope, a lighted scope with a mirror. If needed, your doctor may take a biopsy. If you are experiencing heartburn (gastroesophageal reflux), you doctor may perform a 24-hour pH probe.
Self care & Prevention
- Avoid exposure to irritants in air-conditioning systems, as well as mold, pollen, and pollutants.
- Avoid exposure to extremely cold weather and minimize contact with patients recovering from respiratory illnesses, such as bronchitis or pneumonia.
- Avoid yelling or straining your voice.
- Parents or caregivers should treat children's respiratory infections with care.
- Rest your voice. Don't even whisper. Whispering strains the vocal cords as much as talking.
- Drink plenty of hot liquids. They soothe a sore throat.
- Use steam. Using a steam vaporizer for five minutes four times a day may help ease your symptoms. Taking hot, steamy showers may have a similar effect.
- Try lozenges. Sore-throat lozenges or hard candies may help soothe your throat.
- Don't use mouthwashes. Most contain alcohol and phenol, which may cause throat irritation.
- Don't smoke. It's a major throat and respiratory irritant. Also, avoid secondhand smoke exposure.
- Avoid other respiratory irritants. Dust, chemical fumes, and any fine particulates may aggravate your throat and prolong recovery.