Differentials
Laryngitis
SIGNS / SYMPTOMS
Symptoms <7 days, preceded by upper respiratory infection, and ordinarily self-limited. May present with airway distress and high fever. Exudative tonsillopharyngitis with fever and anterior cervical lymphadenitis is highly suggestive of a bacterial origin.
INVESTIGATIONS
Generally a clinical diagnosis, although indirect laryngoscopy may be performed to rule out laryngeal cancer. Chronic laryngitis lasting >3 weeks should be referred to a specialist.
Fungal laryngitis
SIGNS / SYMPTOMS
There is often an associated infection of the oral cavity and oropharynx demonstrating signs of thrush.
More common in patients who have history of immunosuppression or who take corticosteroids (in particular inhaled corticosteroids).
Neck masses are uncommon.
INVESTIGATIONS
Biopsy and fungal culture distinguish this disorder from malignancy.
Sarcoidosis
SIGNS / SYMPTOMS
Often associated with nasal congestion and obstruction, and dyspnea on exertion. Patients may have a known diagnosis of sarcoidosis.
INVESTIGATIONS
Localized pale edema, submucosal nodules on laryngoscopy, noncaseating granulomas on histopathology. Hilar adenopathy on chest x-ray and increased ACE levels.
Tuberculosis (TB)
SIGNS / SYMPTOMS
History of known TB, PPD positive, known risk factors for TB infection (e.g., homelessness, incarceration, HIV positive).
INVESTIGATIONS
Laryngoscopy shows multiple nodular lesions (similar findings to laryngeal cancer). Biopsy and culture of lesions distinguish TB.[35]
Granulomatosis with polyangiitis (formerly known as Wegener granulomatosis)
SIGNS / SYMPTOMS
Patients may present with nasal congestion, nasal crusting, cough and difficulty breathing, and hematuria. May have a known history of granulomatosis with polyangiitis.
INVESTIGATIONS
Laryngoscopy shows acute, erythematous friable mucosa and subglottic narrowing.[36] Biopsy of lesions is diagnostic; may demonstrate vasculitis. Serum tests of cytoplasmic-staining antineutrophil cytoplasmic antibodies may be diagnostic, but sensitivity is only 65% to 75%.
GERD, laryngopharyngeal reflux disease (LPRD)
SIGNS / SYMPTOMS
Patients with GERD/LPRD have other symptoms including dyspepsia, heartburn, chronic cough, and foul or sour taste which are usually associated with meals or worse when lying down.
INVESTIGATIONS
Manometry, flexible laryngoscopy, response to reflux drugs, or lifestyle modifications.
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