Health Library LaryngitisFrom Healthwise

What is laryngitis?

Laryngitis is an inflammation of the voice box, or larynx, that causes your voice to become raspy or hoarse.

See a picture of the larynx (say “LAIR-inks”).

Laryngitis can be short-term or long-lasting (chronic). Most of the time, it comes on quickly and lasts no more than 2 weeks.

Chronic symptoms are those that last 2 weeks or longer. Check with your doctor if your symptoms last more than 2 weeks, because your laryngitis may be caused by more severe problems.

What causes laryngitis?

Laryngitis can be caused by:

• Colds or flu. This is the most common cause.
• Acid reflux, also known as gastroesophageal reflux disease (GERD). This type of laryngitis is also called reflux laryngitis.
• Overuse of your voice, such as cheering at a sports event.
• Irritation, such as from allergies or smoke.

Acid reflux is the most common cause of chronic laryngitis. But chronic laryngitis may be caused by more severe problems such as nerve damage, sores, polyps, or hard and thick lumps (nodules) on your vocal cords. The vocal cords are the elastic bands inside the larynx that produce your voice.

Some hoarseness may occur naturally with age as your vocal cords loosen and grow thinner.

What are the symptoms?

The main symptom of laryngitis is hoarseness. Your voice may sound raspy, be deeper than normal, or break now and then. You may lose your voice completely. Other symptoms may include a dry or sore throat, coughing, and trouble swallowing.

More severe symptoms may mean there is another problem. A child who has severe pain, drooling, and a hard time breathing may have epiglottitis, a serious condition that requires emergency care. Adults also get epiglottitis, but it is more common in children.

How is laryngitis diagnosed?

Your doctor can identify laryngitis by doing a physical exam that will probably include feeling your neck for sensitive areas or lumps and looking at your nose, mouth, and throat for inflammation. Your doctor may also ask questions such as: When did your voice problem begin? Does it seem to be related to an illness? The way your vocal cords look and the sound of your voice will help your doctor find out if your laryngitis will go away on its own or if you need treatment.

Your doctor may refer you to a specialist (otolaryngologist) if you have voice problems and hoarseness that do not have an obvious cause and that last longer than 2 weeks. A specialist may examine your vocal cords with a small mirror or a special scope.

How is it treated?

With most cases of laryngitis, home treatment is all that you need. Try to rest your voice, add moisture to the air in your home with a humidifier or vaporizer, and drink plenty of fluids. Don't smoke, and stay away from other people’s smoke.

Chronic laryngitis may need more treatment. If you keep getting laryngitis because of a problem with the way you talk or sing, you may need speech training. This can help you change habits that can cause laryngitis. It can also help your larynx heal.

You may need surgery if your vocal cords have been damaged, such as by sores or polyps.

Frequently Asked Questions

The main symptom of laryngitis is a hoarse, weak, raspy, or breathy voice. In some cases, you may not be able to talk at all. You may have a sore throat before you begin to have voice problems, and you may continue to have some degree of throat discomfort as the quality of your voice declines.

You may first notice voice-related symptoms when you wake up in the morning. It may take more effort for you to speak, and your voice may not sound normal. You also may cough or feel an urge to clear your throat, especially if your condition is caused by a virus or other infection.

Symptoms are usually temporary unless there is another underlying problem. If your symptoms also include severe pain, difficulty swallowing, coughing up blood, or a noticeable lump in your neck, you should see a doctor right away. A child who has severe pain, drooling, and difficulty breathing may have epiglottitis, a serious condition that requires emergency care. Adults also get epiglottitis, but it is more common in children.

See a picture of laryngitis.

Common causes of laryngitis

Laryngitis is most often caused by:

• An upper respiratory infection (URI) caused by a virus, such as the common cold. Most cases of laryngitis occur with or follow a URI and may be associated with related postnasal drip and coughing. Symptoms may also include a stuffy or runny nose and a slight fever.
• Gastroesophageal reflux disease (GERD). Acids from the stomach can irritate and inflame the larynx, a condition known as reflux laryngitis. Symptoms of reflux (such as heartburn) aren't always noticed. Laryngitis may be the first sign of reflux in some people.
• Environmental exposures. Coughing and postnasal drip may also contribute to laryngitis after a person has been exposed to allergens or irritants. Cigarette smoke, including secondhand smoke, is a common irritant.
• Strain or overuse. A voice that is hoarse, raspy, or weak may result from excessive use, such as after cheering at a sports event. For more information, see Voice Problems.

Although rare, a fungus may cause a respiratory infection and laryngitis in a person who has an impaired immune system.

Indications of chronic symptoms

Most cases of laryngitis improve after a few days and go away without treatment. However, if symptoms become chronic, the larynx may be damaged. For example, if you have chronic reflux laryngitis, you may develop nodules with sores on your larynx. You will also have an increased risk for developing cancer in your throat.

Symptoms that do not improve after 2 weeks may indicate a chronic problem or another condition that can damage the larynx. It is important to see your health professional to diagnose the cause of long-term symptoms.

When to see your health professional

Although symptoms of laryngitis usually go away within a few days, they may take as long as 2 weeks to clear up completely. Talk to or visit your health professional if symptoms come on suddenly with no apparent cause and do not improve within a few days. If you have severe pain or difficulty swallowing, or you are coughing up blood, see your doctor immediately.

Medical history and physical exam

To diagnose laryngitis, your health professional will ask about your recent medical history and conduct a physical exam. He or she will feel your neck for sensitive areas or lumps and look at your nose, mouth, and throat for inflammation. This helps him or her determine whether your symptoms are related to laryngitis or to another condition.

When to see a specialist

You may be referred to an ear, nose, and throat specialist (otolaryngologist) when:

• Your symptoms have not improved or gone away after 2 weeks.
• You have sudden symptoms that cause severe pain (especially pain radiating up into your ear), difficulty swallowing, or you are coughing up blood.
• Another condition is suspected from your medical history and physical exam.
• Your health professional thinks that the cause of your laryngitis may become chronic and lead to another condition. For example, if you are a professional singer who occasionally develops laryngitis, a specialist may help you improve your singing technique to prevent you from developing nodules or polyps on your larynx.

If the specialist determines that your voice problems are more serious than larynx inflammation or laryngitis, you may have additional tests, such as:

• A laryngoscopy. For this test, the doctor inserts a flexible tool (such as a fiberscope) in your throat, which allows a detailed view of your throat and larynx. During this test, the doctor may also collect a sample of larynx tissue for a biopsy. The tissue is examined to rule out cancer or another serious problem. Cancer is of special concern if you smoke and have lumps around your larynx.
• A video laryngostroboscopy. This test allows the doctor to view the rapid vibration of your vocal cords using a lighted instrument.

Other tests will depend upon the nature of the suspected larynx damage.

Most often, laryngitis is caused by an upper respiratory infection, such as a cold. Home treatment measures similar to those used for a cold, such as resting your voice and drinking fluids, are usually all that is needed. Laryngitis caused by overuse also will go away with voice rest and other home treatment measures. However, if the problem persists or keeps coming back, voice training may be needed.

Gastroesophageal reflux disease (GERD) is a common cause of laryngitis. Home treatment measures to help decrease the amount of stomach acid produced may help manage the problem. Over-the-counter or prescription medications may also be needed. If GERD is not treated and it becomes a chronic condition, it could cause long-term hoarseness and sores (ulcers) on the larynx.

Other conditions with symptoms similar to laryngitis will require treatment according to the specific problem.

Laryngitis symptoms usually go away on their own within 2 weeks. You can help speed your recovery with the following home treatment:¹

• Rest your voice. You do not have to stop speaking entirely, but use your voice as little as possible. Speak softly but do not whisper because whispering can actually irritate your larynx more than speaking softly. Avoid talking on the telephone or trying to speak loudly.
• Try not to clear your throat. This can cause further injury and inflammation to your larynx. Taking a nonprescription cough suppressant medication may help if you have a dry cough that does not produce mucus.
• Stop smoking and stay away from secondhand smoke. Cigarette smoke irritates the throat and larynx and makes existing inflammation worse.
• Use a humidifier in your home. Humidity helps to thin the mucus in the nasal membranes that causes stuffiness or postnasal drip.
• Drink plenty of fluids.
• Relieve nasal stuffiness. The nose helps to humidify inhaled air, which keeps mucus at its proper consistency. A saline nasal wash may help.
• Treat and prevent gastroesophageal reflux. To help prevent or lessen reflux that can irritate or damage your larynx, try not to eat shortly before going to bed, reduce the amount of coffee and alcohol you drink, and eat healthy foods. Taking nonprescription acid reducers can help when these prevention measures are not enough.

Online Resource

Organizations

• Croup
• Gastroesophageal Reflux Disease (GERD)
• Respiratory Problems, Age 11 and Younger
• Respiratory Problems, Age 12 and Older
• Voice Problems

Citations

1. Woodson GE (2001). Acute laryngitis. In Ear, Nose, and Throat Disorders in Primary Care, pp. 159–164. Philadelphia: W.B. Saunders.

Other Works Consulted

• Buckmire R (2005). Hoarseness and laryngitis. In RE Rakel, ET Bope, eds., Conn's Current Therapy 2005. pp. 240–243. Philadelphia: Elsevier Saunders.

• Caserta MT (2005). Acute laryngitis. In GL Mandell et al., eds., Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, 6th ed., vol. 1, pp.758–759. Philadelphia: Elsevier/Churchill Livingstone.

• Koufman JA, Belafsky PC (2003). Infectious and inflammatory diseases of the larynx. In JB Snow, JJ Ballenger, eds., Ballenger's Otorhinolaryngology Head and Neck Surgery, 16th ed., pp. 1185–1217. Hamilton, ON: BC Decker.

• Rosen CA, et al. (2001). Hoarseness and other voice disorders. In KH Calhoun, ed., Expert Guide to Otolaryngology, pp. 325–341. Philadelphia: American College of Physicians.

• Rubin MA, et al. (2005). Infections of the upper respiratory tract. In DL Kasper et al., eds., Harrison's Principles of Internal Medicine, 16th ed., pp. 185–193. New York: McGraw-Hill.

Author:	Ralph Poore	Last Updated: February 16, 2007
Medical Review:	Kathleen Romito, MD - Family Medicine Charles M. Myer, III, MD - Otolaryngology
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