What are the causes of recurrent laryngitis?

From the Guidelines

Recurrent laryngitis is best managed by identifying and addressing the underlying cause, with imaging studies indicated if a healthcare provider suspects a lesion along the recurrent laryngeal nerve, as suggested by the clinical practice guideline: hoarseness (dysphonia) study 1. When managing recurrent laryngitis, it is essential to consider the potential causes, such as vocal strain, respiratory infections, allergies, or gastroesophageal reflux disease (GERD).

• Limiting voice use for 3-7 days during acute episodes and drinking 8-10 glasses of water daily can help keep vocal cords hydrated.
• Over-the-counter pain relievers like acetaminophen (500-1000mg every 6 hours) or ibuprofen (400-600mg every 6-8 hours) can help with discomfort.
• For symptom relief, try steam inhalation for 10-15 minutes twice daily and throat lozenges containing menthol or benzocaine.
• If allergies contribute to laryngitis, consider antihistamines like loratadine (10mg daily) or cetirizine (10mg daily).
• Avoid irritants such as smoking, alcohol, spicy foods, and caffeine.
• For persistent cases lasting beyond 2-3 weeks, see a healthcare provider as prescription medications like proton pump inhibitors (if reflux is involved) or antibiotics (for bacterial infections) may be necessary.
• Voice therapy with a speech pathologist is beneficial for those with poor vocal habits. In cases where a lesion is suspected, imaging studies such as CT or MRI can be valuable tools in diagnosing the cause of hoarseness, as noted in the study 1.
• Unexplained vocal fold paralysis found on laryngoscopy warrants imaging the skull base to the thoracic inlet/arch of the aorta.
• Lesions at the skull base and brain are best evaluated using an MRI of the brain and brain stem with gadolinium enhancement.
• Primary lesions of the larynx, pharynx, subglottis, thyroid, and any pertinent lymph node groups can also be evaluated by imaging the entire area.

From the Research

Definition and Symptoms of Recurrent Laryngitis

• Recurrent laryngitis is not explicitly defined in the provided studies, but chronic laryngitis is described as an inflammatory process of at least 3 weeks duration that affects phonation, breathing, and swallowing 2.
• Symptoms of chronic laryngitis are nonspecific and may range from mild to airway compromise requiring emergent tracheostomy 2.

Causes of Recurrent Laryngitis

• The causes of recurrent laryngitis are not directly addressed in the provided studies, but acute laryngitis is described as a common illness worldwide, often diagnosed by case history alone and treated by controlling symptoms 3, 4, 5.
• Laryngeal inflammation can be present secondary to direct effects of irritants, toxins, and antigens, as well as mechanical and infectious effects, and secondary inflammation from behavioral mechanisms 6.

Treatment of Recurrent Laryngitis

• The effectiveness of antibiotics in treating acute laryngitis is assessed in several studies, with results indicating that antibiotics appear to have no benefit in treating acute laryngitis when assessing objective outcomes 3, 4, 5.
• However, erythromycin may reduce voice disturbance at one week and cough at two weeks when measured subjectively 3, 4, 5.
• Fusafungine may increase the cure rate at day five, but the included RCTs had important methodological problems, and these modest benefits from antibiotics may not outweigh their cost, adverse effects, or negative consequences for antibiotic resistance patterns 3.