Laryngitis: Symptoms, Causes and Treatment
Laryngitis, also known as laryngotracheitis or croup, depending on its mode of presentation, is the inflammation of the laryngeal mucosa. There are quite significant differences between the symptoms of adults and children, the latter being the most affected.
Its main cause is viral infections. At the same time, the therapeutic options are wide, prioritizing the relief of symptoms and the administration of drugs that eliminate the cause of the inflammation.
What is laryngitis?
Laryngitis is a disease or condition characterized by the persistent inflammation of the laryngeal mucosa. This organ is made up of cartilage and some ligaments and muscles that allow the articulation of phonation.
The larynx is the upper limit of the airway, through which air passes to enter the lungs. If viewed from its upper opening, a space called the glottis could be seen. This is covered by a cartilaginous structure called the epiglottis, which opens and closes during swallowing in order to prevent food from entering the airway and obstructing it.
How frequent is it?
Being a benign and self-limiting condition, cases are often underreported. However, there are some indicative data that can help us understand the epidemiological reality of laryngitis.
According to the Spanish Pediatric Emergency Society, laryngitis is very common in male children during the autumn and winter months. The most affected ages are those between 3 months and 6 years.
Compared to adults, it tends to be more common. This is probably due to the size of the airway and the susceptibility of these ages to acquire respiratory infections.
Laryngitis in adults and children
The clinical presentation of this pathology is different when comparing children with adults. The most important aspects to consider are the location of the inflammation, the associated symptoms and the evolution of the disease.
Due to the anatomical differences in the airways of children and adults, the area affected can vary greatly. Thus, in children, subglottic involvement (below the glottis) is common, while in adults the supraglottic portion (above the glottis) tends to be affected more frequently.
This variation, in turn, causes different symptoms. While in children there’s a lot of difficulty breathing (dyspnea), in adults the distortion of the tone of voice (dysphonia) is the most frequent.
In both cases, inflammation involves a series of processes that lead to reddening of the mucosa, partial loss of function, some pain, and edema or swelling. This last factor is the most dangerous of all, since it compromises life by obstructing the airway.
In children, who have a much narrower larynx, edema in the mucosa could lead to severe consequences. This is why, despite being very rare, it’s advisable to see a doctor if you suspect laryngitis, especially during the first years of life.
Clinical manifestations of laryngitis
In laryngitis, it’s possible to observe a well-defined pattern that varies according to the age of the patient. In addition to dysphonia, pain, and shortness of breath, other manifestations may be the following:
- Pain or difficulty swallowing: The close relationship of this structure with the esophagus (part of the digestive system) can cause irritation and local pain.
- Reflex ear pain: This is a kind of referred pain in which patients report pain in one of the ears without localized inflammation.
- Inspiratory stridor: This is a short, high-pitched sound that occurs during inhalation. It’s the consequence of the rapid passage of air.
- Dog cough: This is very characteristic in children. It’s defined as dry, metallic, and coarse.
- Shaking and crying: This can happen in infants and preschoolers with respiratory distress. In addition, as these are situations that require greater ventilation and oxygen supply, the other symptoms worsen.
- Bluish coloration in fingers: This is called cyanosis and is the direct consequence of decreased oxygen supply. It’s only seen in severe cases where the integrity of the airway is compromised.
Causes of laryngitis
The list is quite extensive and sometimes can’t be clearly defined due to the abrupt presentation of the symptoms. For practical purposes, both infectious and non-infectious causes are recognized.
Infectious causes
Viral agents are the most common. These include the influenza virus, parainfluenza, and respiratory syncytial, causing something similar to the flu. Sometimes the herpes simplex virus is also involved.
This last condition is known as herpetic laryngitis and is quite rare. In a 2013 report, the case of a 7-month-old female infant who suffered progressive respiratory distress, fever, and stridor was described.
Several days prior to her hospital admission, she had oral eruptions associated with frequent crying. In this case, the patient evolved satisfactorily after the administration of the specific medication, acyclovir.
Other infectious agents that cause laryngitis include bacteria, which can also affect adults. Mycoplasma pneumoniae is one of them, closely related to the appearance of pneumonia.
Non-infectious causes
These are much less common, with the exception of hypersensitivity or allergy laryngitis. In this case, exposure to an allergenic agent (that is, one capable of triggering an allergy) causes systemic symptoms, such as itching, profuse sweating, skin rashes, and difficulty breathing.
Dyspnea is due to inflammation in the airway. It isn’t always limited to the larynx, since it can cover a good part of the bronchi. Sometimes it can resolve spontaneously, but complications are common.
The intake of irritating substances can also cause laryngitis. For example, the consumption of caustics, such as bleach and chlorine, for intentional or accidental reasons. However, the damage to the digestive system is much greater.
Gastroesophageal reflux is a disease that has important consequences outside the digestive system. One of them is non-infectious laryngitis, also known as laryngopharyngeal reflux. It has the particularity of occurring in a long-lasting or chronic way, requiring the solution of the underlying problem to alleviate the symptoms.
Diagnosis
The diagnosis of laryngitis is clinical, especially when a simple examination allows the physician to visualize the glottis without the aid of special equipment. However, this isn’t always possible, so some procedures are necessary to assess the airway.
Nasofibrolaryngoscopy is one of these interventions, usually carried out by otolaryngologists. The visualization of inflammation with edema and redness allows them to make the diagnosis without much effort.
Sometimes, the doctor may ask for imaging studies such as an X-ray or CT scan. These allow them to visualize inflammation around the larynx and determine the involvement of nearby soft tissues.
Some blood studies could be useful, such as a complete blood count. In it, an increase of white blood cells is detected in laryngitis of infectious origin, although it isn’t an essential test.
laryngitis treatment
Treatment of this condition depends on the cause. If it’s possible to identify a triggering factor, the relief of the symptoms will be carried out jointly with the elimination of the main cause.
Said relief can be provided by the administration of oxygen therapy and nebulizations. The use of corticosteroids by any route is still somewhat controversial, but it’s incorporated into almost all action protocols. They have an excellent ability to decrease inflammation.
Antiallergics, especially antihistamines, and mucolytic substances, such as n-acetylcysteine, could help in cases with mucous production or allergic origin. The administration of antibiotics, antifungals, or antivirals should eliminate the corresponding cause.
Laryngitis is almost always benign
In the vast majority of cases, laryngitis is a benign process. Only in some very specific conditions (small children, severe infections, or immunosuppressed patients) can the symptoms progress to partial or total obstruction of the airways.
In principle, it’s advisable to go to the emergency services. These will have family doctors, internists, or pediatricians depending on the patient’s profile. Sometimes the otolaryngologist may be involved in the process.
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