Laryngitis
Causes
Certain viruses or bacteria can infect the larynx and cause it to swell. Usually, the virus comes from another illness, such as a cold, the flu, or bronchitis. Laryngitis can also occur from using the voice too much (singing or shouting). Chronic laryngitis can be caused by heavy smoking, excessive alcohol use, or acid reflux (gastroesophageal reflux disease or GERD), caused when stomach acid backs up into the esophagus.
Signs and Symptoms
- Hoarseness
- Loss of voice
- Tickling, scratchiness, and rawness in your throat
- A constant urge to clear your throat
Risk Factors
- Smoking
- Overusing your voice
- Having an upper respiratory infection like a cold, flu, or bronchitis
Diagnosis
Your doctor will examine your throat and take a culture if it looks infected. If you have had laryngitis for a long time, especially if you are a smoker, your doctor may do a test called a laryngoscopy, using a thin, flexible tube with a tiny camera to look in the back of your throat.
Treatment Approach
In most cases, you can treat laryngitis yourself by resting your voice. Antibiotics are not recommended because most cases of laryngitis are caused by a virus.
Lifestyle
- Rest your voice for a week or so. DO NOT whisper, as that puts more strain on your vocal chords.
- If you smoke, stop.
- Avoid clearing your throat as much as possible.
- Avoid drinking alcohol.
- Use a humidifier or inhale steam from a bowl of hot water.
- Keep your throat moist by sucking on lozenges or chewing gum.
- Gargle several times a day with ½ tsp. of salt in a glass of warm water.
Medications
Medications are rarely needed for laryngitis. However, depending on the cause of your laryngitis, your doctor may prescribe:
Antibiotics. For laryngitis resulting from a bacterial infection.
Antihistamines or inhaled steroids. For laryngitis resulting from allergies.
Nutrition and Dietary Supplements
Since supplements may have side effects or interact with medications, you should only take them under the supervision of a knowledgeable health care provider.
Some herbs may help shorten the length of a cold or possibly lessen your chances of getting one, which might also help your throat if your laryngitis is due to a cold.
- Honey. Honey has been used traditionally to soothe a sore or irritated throat. It is usually added to a warm herbal tea. Never give honey to an infant under the age of 1.
- Zinc lozenges. Some people may find that sucking on zinc lozenges improves symptoms. If you do decide to try zinc lozenges, remember that getting too much zinc (more than 50 mg per day over a long period of time) can be dangerous.
Herbs
The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, you should take herbs with care, under the supervision of a health care practitioner.
Eucalyptus (Eucalyptus globulus). Eucalyptus is used in many remedies to treat cold symptoms, particularly cough, but it may also help soothe a sore or irritated throat. It can be found in many lozenges, cough syrups, and vapor baths throughout the United States and Europe. You can also use fresh leaves in teas and gargles to soothe sore throats. DO NOT take eucalyptus oil by mouth because it can be poisonous.
Licorice (Glycyrrhiza glabra). Licorice root is a traditional treatment for sore throat, although scientific evidence is lacking. Licorice interacts with a number of medications, so ask your doctor before taking it. People with high blood pressure, kidney disease, liver disease, or heart disease, women who are pregnant or breastfeeding, and those who take blood thinners, such as aspirin or warfarin (Coumadin), should not take licorice.
Marshmallow (Althea officinalis). Although scientific evidence is lacking, marshmallow has been used traditionally to treat sore throat and cough. It contains mucilage, which coats the throat and may help relieve irritation. Marshmallow can potentially interfere with several medications, including lithium. It can also potentially reduce blood sugar levels. If you have diabetes or hypoglycemia, speak with your doctor. DO NOT take marshmallow at the same time of day as prescription medications.
Peppermint (Mentha x piperita). Like eucalyptus, peppermint is widely used to treat cold symptoms. Its main active agent, menthol, is a good decongestant, but peppermint is also soothing for sore throats and dry coughs. DO NOT use peppermint or menthol with infants. DO NOT take peppermint oil by mouth.
Slippery elm (Ulmus fulva). Although scientific evidence is lacking, slippery elm may help ease a sore throat and has been used traditionally for this purpose. Like marshmallow, it contains mucilage, which coats the throat and relieves irritation. Slippery elm may also affect how your body absorbs some medications, so wait at least one hour after taking any other medications before taking slippery elm. Pregnant or breastfeeding women should avoid slippery elm.
Some people may find relief gargling these teas:
- Chamomile (Matricaria recutita)
- Sage (Salvia officinalis)
- Blackberry (Rubus fruticosus)
Homeopathy
There have been few studies examining the effectiveness of specific homeopathic remedies. A professional homeopath, however, may recommend one or more of the following treatments for laryngitis based on his or her knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type. In homeopathic terms, a person's constitution is their physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.
- Aconitum. For laryngitis that comes on after exposure to cold and may be accompanied by a dry cough.
- Allium cepa. For hoarseness associated with a cold and clear, watery discharge.
- Argenticum nitricum. For laryngitis in nervous, restless individuals that may be brought on by yelling or singing.
- Causticum. Most commonly used remedy for individuals who have laryngitis, particularly with mucus in the throat or laryngitis due to overuse of the voice; coughing is aggravated by chilly weather and relieved by cold drinks; symptoms worsen at night.
- Hepar sulphuricum. For laryngitis with barking cough that worsens in the morning.
- Kali bichromicum. For laryngitis with a cough that is characterized by a stringy yellow mucus; this remedy is most appropriate for individuals who have a tickling sensation in the back of the throat with symptoms that worsen after drinking
- Phosphorus. For individuals with a hoarse, dry cough and a burning sensation in the throat; symptoms tend to be relieved by cold liquids; this remedy is most appropriate for individuals who tend to be nervous if alone and prefer the company of others
Other Considerations
Warnings and Precautions
If you have problems breathing or swallowing, or if your throat bleeds, seek emergency medical attention. Call your health care provider if you have a fever above 102°F (38.9°C).
Prognosis and Complications
For adults, laryngitis rarely causes serious problems. However, two conditions that may occur in children include:
- Croup, which narrows the airway passages, causes difficulty breathing, and leads to a "barking" cough.
- Epiglottitis, which is inflammation of the epiglottis, the flap of cartilage at the back of the tongue that closes off the windpipe when swallowing. If it swells, the child may have trouble breathing.
Supporting Research
Audera C, Patulny RV, Sander BH, Douglas RM. Mega-dose vitamin C in treatment of the common cold: a randomised controlled trial. Med J Aust. 2001;175(7):359-62.
Barrett BP, Brown RL, Locken K, Maberry R, Bobula JA, D'Alessio D. Treatment of the common cold with unrefined Echinacea: a randomized, double-blind, placebo-controlled trial. Ann Intern Med. 2002;137:936-46.
Belongia EA, Berg R, Liu K. A randomized trial of zinc nasal spray for the treatment of upper respiratory illness in adults. Am J Med. 2001;111(2):103-8.
Botto H, Antonioli C, Nieto M, et al. Severe laryngitis associated to gastroesophageal reflux. Arch Argent Pediatr. 2014;112(1):78-82.
Charuluxananan S, Sumethawattana P, Kosawiboonpol R, Somboonviboon W, Werawataganon T. Effectiveness of lubrication of endotracheal tube cuff with chamomile-extract for prevention of postoperative sore throat and hoarseness. J Med Assoc Thai. 2004 Sep;87 Suppl 2:S185-9.
Douglas RM, Chalker EB, Treacy B. Vitamin C for preventing and treating the common cold. Cochrane Database Syst Rev. 2000;(2):CD000980.
Ferri: Ferri's Clinical Advisor 2016. Philadelphia, PA: Elsevier; 2016.
Hirt M, Nobel Sion, Barron E. Zinc nasal gel for the treatment of common cold symptoms: A double-blind, placebo-controlled trial. ENT J. 2000;79(10):778-80, 782.
Jackson JL, Lesho E, Peterson C. Zinc and the common cold: a meta-analysis revisited. J Nutr. 2000;130(5S Suppl):1512S-15S.
Kassel JC, King D, Spurling GK. Saline nasal irrigation for acute upper respiratory tract infections. Cochrane Database Syst Rev. 2010 Mar 17;(3):CD006821. Review.
Kligler B. Echinacea. Am Fam Physician. 2003;67(1):77-80.
Lindenmuth GF, Lindenmuth EB. The efficacy of echinacea compound herbal tea preparation on the severity and duration of upper respiratory and flu symptoms: a randomized, double-blind placebo-controlled study. J Altern Complement Med. 2000;6(4):327-34.
Mahady GB. Echinacea: recommendations for its use in prophylaxis and treatment of upper respiratory tract infections. Nutr Clin Care. 2001;4(4):199-208.
McElroy BH, Miller SP. Effectiveness of zinc gluconate glycine lozenges against the common cold in school-aged subjects: a retrospective chart review. Am J Ther. 2002;9(6):472-5.
Melchart D, Linde K, Fischer P, Kaesmayr J. Echinacea for preventing and treating the common cold. [Review]. Cochrane Database Syst Rev. 2000;(2):CD000530.
Paul IM, Beiler J, McMonagle A, Shaffer ML, Duda L, Berlin CM. Effect of honey, dextromethorphan, and no treatment on nocturnal cough and sleep quality for coughing children and their parents. Arch Pediatr Adolesc Med. 2007;161(12):1140-6.
Pendleton H, Ahlner-Elmqvist M, Jannert M, Ohlsson B. Posterior laryngitis: a study of persisting symptoms and health-related quality of life. Eur Arch Otorhinolaryngol. 2013;270(1):187-95.
Prasad AS, Fitzgerald JT, Bao B, Beck FW, Chandrasekar PH. Duration of symptoms and plasma cytokine levels in patients with the common cold treated with zinc acetate. A randomized, double-blind, placebo-controlled trial. Ann Intern Med. 2000;133(4):245-52.
Rakel R, Bope E. Rakel & Bope: Conn's Current Therapy 2008. 60th ed. Philadelphia, PA: Elsevier Saunders. 2008:61.
Reiter R, Brosch S. Chronic laryngitis-associated factors and voice assessment. Laryngorhinootologie. 2009;88(3):181-5.
Reveiz L, Cardona AF. Antibiotics for acute laryngitis in adults. Cochrane Database Syst Rev. 2013;3:CD004783.
Roxas M, Jurenka J. Colds and influenza: a review of diagnosis and conventional, botanical, and nutritional considerations. Altern Med Rev. 2007 Mar;12(1):25-48. Review.
Shah SA, Sander S, White CM, Rinaldi M, Coleman CI. Evaluation of echinacea for the prevention and treatment of the common cold: a meta-analysis. Lancet Infect Dis. 2007 Jul;7(7):473-80. Review. Erratum in: Lancet Infect Dis. 2007 Sep;7(9):580.
Simasek M, Blandino DA. Treatment of the common cold. Am Fam Physician. 2007 Feb 15;75(4):515-20. Review.
Turner RB. Ineffectiveness of intranasal zinc gluconate for prevention of experimental rhinovirus colds. Clin Infect Dis. 2001;33(11):1865-70.
Turner RB, Riker DK, Gangemi JD. Ineffectiveness of Echinacea for prevention of experimental rhinovirus colds. Antimicrob Agents Chemother. 2000;44:1708-9.
Vaezi MF. Laryngeal manifestations of gastroesophageal reflux disease. Curr Gastroenterol Rep. 2008;10(3):271-7.
Van Straten M, Josling P. Preventing the common cold with a vitamin C supplement: a double-blind, placebo-controlled survey. Adv Ther. 2002;19(3):151-9.
Yale SH, Liu K. Echinacea purpurea therapy for the treatment of the common cold: a randomized, double-blind, placebo-controlled clinical trial. Arch Intern Med. 2004 Jun 14;164(11):1237-41.