Laryngitis
Laryngitis: Excerpt from Professional Guide to Diseases (Eighth Edition)
A common disorder, laryngitis is an acute or chronic inflammation of the vocal cords. Acute laryngitis may occur as an isolated infection or as part of a generalized bacterial or viral upper respiratory tract infection. Repeated attacks of acute laryngitis produce inflammatory changes associated with chronic laryngitis.
Alert Several forms of laryngitis occur in children and can lead to significant or fatal respiratory obstruction, such as croup and epiglottiditis.
Causes
Acute laryngitis usually results from infection (primarily viral) or excessive use of the voice, an occupational hazard in certain vocations (teaching, public speaking, or singing, for example). It may also result from leisure activities (such as cheering at a sports event), inhalation of smoke or fumes, or aspiration of caustic chemicals. Chronic laryngitis may be caused by chronic upper respiratory tract disorders (sinusitis, bronchitis, nasal polyps, or allergy), mouth breathing, smoking, constant exposure to dust or other irritants, and alcohol abuse.
Signs and symptoms
Acute laryngitis typically begins with hoarseness, ranging from mild to complete loss of voice. Associated clinical features include pain (especially when swallowing or speaking), a persistent dry cough, fever, laryngeal edema, and malaise. In chronic laryngitis, persistent hoarseness is usually the only symptom.
Diagnosis
CONFIRMING DIAGNOSIS Indirect laryngoscopy confirms the diagnosis by revealing red, inflamed and, occasionally, hemorrhagic vocal cords, with rounded rather than sharp edges and exudate. Bilateral swelling may be present.
In severe cases or if toxicity is a concern, a culture of the exudate is obtained. Consider 24-hour pH probe testing in chronic laryngitis and gastroesophageal reflux disease (GERD). Also consider biopsy in chronic laryngitis in an adult with a history of smoking or alcohol abuse.
Treatment
Primary treatment consists of resting the voice. For viral infection, symptomatic care includes analgesics and throat lozenges for pain relief. Bacterial infection requires antibiotic therapy. Severe, acute laryngitis may necessitate hospitalization. When laryngeal edema results in airway obstruction, a tracheostomy may be necessary. In chronic laryngitis, effective treatment must eliminate the underlying cause. Antacids or histamine-2 blockers may be used if GERD is the cause. Steam inhalation may also prove beneficial as are smoking cessation, reducing alcohol intake, and job change or modification if warranted.
Special considerations
❑ Explain to the patient why he shouldn’t talk, and place a sign over the bed to remind others of this restriction. Provide a Magic Slate or a pad and pencil for communication. Mark the intercom panel so other facility personnel are aware that the patient can’t answer. Minimize the need to talk by trying to anticipate the patient’s needs.
❑ For the patient with a bacterial infection, stress the importance of completing the full course of antibiotic therapy.
❑ Suggest that the patient maintain adequate humidification by using a vaporizer or humidifier during the winter, by avoiding air conditioning during the summer (because it dehumidifies), by using medicated throat lozenges, and by not smoking.
❑ Obtain a detailed patient history to help determine the cause of chronic laryngitis. Encourage the patient to modify predisposing habits, especially to stop smoking.
❑ Provide the patient with assistance for smoking cessation as well as for modification of other predisposing habits or occupational hazards.
Book Source Details
- Book Title: Professional Guide to Diseases (Eighth Edition)
- Author(s): Springhouse
- Year of Publication: 2005
- Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.
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Medical Books Excerpts
- Laryngitis
- "Professional Guide to Diseases (Eighth Edition)" (2005)
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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