From the Guidelines
Bacterial laryngitis is suggested by severe symptoms, such as high fever, purulent sputum, severe throat pain, and localized inflammation with possible exudates or abscesses on the vocal cords, as opposed to viral laryngitis which is typically self-limited and resolves within 7 to 10 days 1. When considering the etiology of laryngitis, it's crucial to distinguish between bacterial and viral causes to guide appropriate treatment and avoid misuse of antibiotics. The key features that suggest a bacterial etiology include:
- High fever, often above 101°F
- Purulent or discolored sputum
- Severe throat pain
- Visibly swollen lymph nodes in the neck
- Unilateral throat pain
- Localized inflammation with possible exudates or abscesses on the vocal cords
- Rapid and severe onset of symptoms
- History of recent bacterial infections elsewhere in the respiratory tract or exposure to bacterial pathogens
- Symptoms persisting beyond 2-3 weeks
- Laboratory findings showing elevated white blood cell count with neutrophil predominance It's essential to note that antibiotics are only effective in bacterial infections, and their routine empiric use in treating patients with dysphonia is unwarranted, as most cases are caused by acute viral laryngitis 1. Antibiotics may be appropriate in select circumstances, such as in immunosuppressed patients or those with dysphonia secondary to other bacterial infections 1.
From the Research
Features Suggesting Bacterial Etiology
- Prolonged duration of symptoms, such as long-standing hoarseness and exudative laryngitis 2
- Presence of methicillin-resistant staphylococcus aureus (MRSA) or other bacterial pathogens 2
- Failure to respond to initial antibiotic treatment, with recurrence or nonresolution of infection 2
- Presence of underlying comorbidities, such as smoking and reflux, although this association is not statistically significant 2
Diagnostic Considerations
- Diagnosis of chronic bacterial laryngitis is based on clinical history and findings on flexible laryngoscopy, with operative biopsy used in selected cases to confirm the diagnosis 2
- Laryngeal tissue culture may be used to identify the responsible bacterial pathogen, such as MRSA 2
Treatment Implications
- Prolonged antibiotic therapy is required to clear the infection, with treatment duration of at least 21 days 2
- Empiric treatment with Amoxicillin-clavulonic acid may be used, but MRSA infection may require alternative treatments, such as Sulfamethoxazole and trimethoprim 2
- A treatment algorithm for management of chronic bacterial laryngitis is suggested, taking into account the presence of MRSA and other factors 2