History and exam
Key diagnostic factors
common
hoarseness
The most characteristic symptom of laryngitis.
In acute laryngitis, history of hoarseness is generally <7 days.
There can be periods of aphonia.
Due to increased edema, the bulk of the vocal folds increases, and the normal pitch is lowered.
In tuberculosis, the patient will present with chronic hoarseness (>3 weeks).
dysphagia
Common symptom associated with sore throat.
sore throat
Common symptom of upper respiratory infections.
odynophagia
Pain on swallowing is a common symptom of upper respiratory infections.
cough
Common symptom of upper respiratory infections.
Postnasal drainage and increased laryngeal mucus exacerbate the cough.
Chronic cough with weight loss are symptoms of laryngitis due to tuberculosis.
hyperemia of the oropharynx
Feature of acute infectious laryngitis.
history of heavy vocal use
Patients with vocal strain will usually present with a history of prolonged or excessive vocal use.
gastroesophageal reflux
Untreated reflux can lead to chronic changes in the larynx resulting in chronic inflammation.
uncommon
oropharyngeal white-gray exudates
Seen on oropharyngeal examination in patients with diphtheria.
May extend to the soft palate and vallecula.
These pseudomembranes in diphtheria may also be found covering the laryngeal structures, leading to airway compromise.
Firmly adherent to the underlying mucosa, which bleed when the exudate is removed.
Other diagnostic factors
common
rhinitis
Common symptom of upper respiratory infections.
Postnasal drainage and increased laryngeal mucus may exacerbate cough.
fatigue and malaise
May accompany more localized laryngeal symptoms.
Malaise is profound in diphtheria infection.
fever
Patients with acute infectious laryngitis can present with symptoms varying from very subtle features to high-grade fever.
Fever presenting with exudative tonsillopharyngitis and anterior cervical lymphadenitis is highly suggestive of bacterial origin.
enlarged tonsils
May occur in acute infectious laryngitis.
enlarged, tender anterior cervical lymph nodes
When accompanied by exudative tonsillopharyngitis and fever, highly suggestive of bacterial origin.
postnasal drip
May be detected on oropharyngeal examination and may exacerbate cough.
dyspnea
May occur due to laryngeal edema.
uncommon
weight loss
Weight loss and chronic cough are symptoms of laryngitis due to tuberculosis.
tonsillopharyngeal exudate
When accompanied by anterior cervical lymphadenitis and fever, highly suggestive of bacterial origin.
acute respiratory distress
Generally seen in cases of acute epiglottitis, croup, or diphtheria.
Uncommon with uncomplicated acute laryngitis in adults.
toxic appearance
Generally seen in cases of acute epiglottitis or diphtheria.
Uncommon with uncomplicated acute laryngitis.
drooling
Generally seen in cases of acute epiglottitis. Uncommon with uncomplicated acute laryngitis.
stridor
Generally seen in cases of acute epiglottitis, croup, or diphtheria.
Uncommon with uncomplicated acute laryngitis.
Risk factors
strong
recent history of upper respiratory infection
Symptoms of acute infectious laryngitis are usually preceded by a viral upper respiratory infection and are self-limiting.
incomplete or absent Haemophilus influenzae type B (Hib) vaccination
Epiglottitis is most frequently caused by Haemophilus influenzae type B.
incomplete or absent diphtheria vaccination
Diphtheria as a cause of laryngitis is encountered rarely in the US but can still infect children and adults who are immunocompromised or have not received vaccinations.
contact with infected individual
Most cases of acute infectious laryngitis are caused by viruses that are spread by respiratory droplet transmission.
travel to area where diphtheria or tuberculosis are endemic
Worldwide, diphtheria is endemic in areas such as Africa, Latin America, Asia, the Middle East and Europe. Tuberculosis (TB) is endemic in China and India.
HIV or other immunocompromise
Particularly increases risk for tuberculous and fungal laryngitis. TB is a cause of chronic laryngitis.
use of inhaled corticosteroids or prolonged courses of antibiotics
Increases risk for laryngeal candidiasis.[12]
Risk may be reduced in patients on inhaled corticosteroid if they rinse the throat with water before and after taking their medication, and by using the lowest therapeutic dose. Oral candidiasis can be a side effect of antibiotic use.
heavy vocal use
Patients with laryngitis caused by vocal strain will usually present with a history of prolonged or excessive vocal use.
tobacco use
Patients with tobacco use are at increased risk of having a dry, chemically irritated larynx, and altered vocal fold epithelium contributing to recurrent episodes of laryngitis.[18]
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