ACUTE LARYNGITIS

Saturday, August 16, 2008

Essentials of Diagnosis

• Hoarseness or loss of voice (aphonia).

• Associated symptoms of rhinitis, pharyngitis, or cough.

• Children tend to develop airway obstruction.

• On direct examination, the larynx is hyperemic and edematous, with or without ulcerations.

• Mostly viral, occasionally bacterial.

• Persistent hoarseness lasting > 10 d should prompt laryngoscopy to exclude other etiologies.

General Considerations

Laryngitis is the infection of the larynx that results in an inflammatory reaction and consequential symptoms and signs. Common cold viruses such as rhinovirus, influenza virus, adenoviruses, RSV, or parainfluenza viruses may cause acute laryngitis. It usually presents in winter as part of an upper respiratory tract infectious syndrome. Bacterial laryngitis is less common and is caused mainly by S pyogenes or Moraxella catarrhalis. Rarely laryngitis may be caused by Mycobacterium tuberculosis, syphilis, or fungi such as Histoplasma capsulatum, Blastomyces dermatiditis, or Candida albicans.

Clinical Findings

A. Signs and Symptoms. Hoarseness, aphonia, and symptoms of associated upper respiratory tract infection such as rhinitis or pharyngitis may accompany acute laryngitis. Respiratory obstruction may occur particularly in children. Direct examination when done shows the larynx to be hyperemic and edematous, with or without ulcerations. An exudate or membrane may be seen in diphtheria, streptococcal, or EBV laryngitis.

B. Imaging. Lateral x-ray of the neck may be helpful to exclude acute bacterial epiglottitis or bacterial tracheitis. If symptoms of hoarseness persist beyond 2 wk, patients should be evaluated by direct visualization of the larynx by laryngoscopy.

Differential Diagnosis

Voice abuse is the most frequent noninfectious cause of hoarseness. Differential diagnosis includes tumors, paralysis of the vocal cords, chemical irritants, or gastroesophageal reflux. Patients with laryngitis must also be differentiated from those with acute epiglottitis or bacterial tracheitis, which usually present with more systemic symptoms.

Complications

Respiratory obstruction in children is the most serious complication.

Treatment

Because the majority of laryngeal infections are viral, therapy is mostly supportive with voice rest, warm saline gargles, and increased humidity. If specific microbiologic diagnosis is made with positive microbiologic cultures, then therapy should be directed at the organism isolated.

Prognosis

Long-term prognosis is excellent with no residual symptoms.

Prevention & Control

Preventive measures for laryngitis are similar to those for common cold and pharyngitis.

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