Chronic Laryngitis

Laryngitis may be short-lived (acute) or last for a longer time. Chronic laryngitis is an inflammatory condition affecting the larynx (voice box) which persists for more than three weeks. Laryngitis may have infectious or non-infectious causes. It can affect people of every age and gender, but is more common in men of middle age. However, an increasing number of women work in industrial environments and/or smoke tobacco, and so the prevalence of chronic laryngitis is rising among women. 1

The main symptom of chronic laryngitis is vocal hoarseness, which occurs due to inflammation of the vocal cords in the throat. When the vocal cords are inflamed, this distorts the sounds made in speech, when air passes over them, resulting in hoarseness of voice.

Typical symptoms of long-lasting laryngitis include:

• Vocal hoarseness
• Sore throat
• Coughing
• Swallowing problems

The Ada app can help you check your symptoms. Download the free app or find out more about how it works.

Laryngeal symptoms such as cough, sore throat and hoarse voice are frequently caused by prolonged irritation of the larynx and vocal cords. If laryngitis persists for weeks or months, this can result in vocal cord strain and injuries and growths or polyps developing on the vocal cords.

Non-infectious causes of persistent laryngitis can include:

• Overuse of the voice, which puts a strain on the larynx
• Overuse of alcohol
• Smoking
• Gastroesophageal reflux disease
• Bacterial infections
• Autoimmune disorders
• Postnasal drip
• Allergies
• Surgery or injury to the larynx
• Cancer

Good to know: Bacterial infections rarely cause chronic laryngitis, although MRSA-related chronic laryngitis is becoming more common. 2

Many people who use their voice for a living, such as teachers, call-center employees, singers and lawyers, risk overusing their vocal cords and developing laryngitis as a result. 3 It is possible for prolonged vocal strain to lead to nodules and growths on the vocal cords; these may themselves lead to hoarseness or loss of voice.

Common commercial alcohol beverages can contain not only ethanol but various other compounds and substances that act as irritants in the throat.

Smoke, air pollution and fumes from tobacco products, burning materials, wildfires, industrial processes, chemicals and engines can also irritate the larynx and lead to laryngitis. 1

Gastroesophageal reflux disease (GERD) is a common cause of chronic laryngitis. In this condition, acid from the stomach rises up the esophagus and can cause irritation and a burning sensation in the throat and chest. This acid can cause hoarseness and a painful throat (known as pharyngitis. If you are concerned that you may have GERD that is causing a sore throat or hoarseness, you can do a free symptom assessment using the Ada app at any time.

While viral infections rarely lead to chronic laryngitis, bacterial causes are more common. Bacteria that can lead to chronic laryngitis include: 4

• Methicillin-sensitive staphylococcus aureus
• Methicillin-resistant staphylococcus aureus
• Pseudomonas aeruginosa
• Serratia marcescens

Good to know: Chronic laryngitis caused by MRSA and Pseudomonas aeruginosa need to be confirmed by a doctor’s examination and will require antibiotics to treat. 2

Some diseases caused by bacterial infections, such as syphilis, may also cause chronic laryngitis.

While fungal infections can cause chronic laryngitis, they are extremely rare in people who have healthy immune systems. People affected by immunosuppressive drugs or who have health conditions that lead to weakened immune systems may, however, be vulnerable to chronic laryngitis as a result of fungal infections. 1

Some autoimmune disorders can also increase the risk of developing chronic laryngitis. These include: 1 5

• Wegener’s granulomatosis
• Amyloidosis
• Relapsing polychondritis
• Systemic lupus erythematosus
• Rheumatoid arthritis

Because laryngitis is usually acute, meaning that it goes away on its own after around two weeks, it is wise to seek medical attention if symptoms, including hoarseness of the voice due to inflamed vocal cords, sore throat and/or cough, remain present after this time. The diagnosis of persistent laryngitis is usually made by assessing the symptoms and examining the throat. If you are concerned that you or a loved one may have laryngitis, chronic or acute, or another disorder that is causing hoarseness or throat pain, you can do a free symptom assessment using the Ada app at any time.

In some cases, a doctor will examine the throat of someone who may have chronic laryngitis with a small instrument known as a laryngoscope. This is often done if the affected person has trouble breathing or swallowing, or earache. 6 There are three types of laryngoscopy: ref6

• Indirect laryngoscopy
• Direct fiber-optic laryngoscopy
• Direct laryngoscopy

In an indirect laryngoscopy, the doctor will use a light and mirror to see the back of the throat and the trachea. This procedure is not painful, although doctors can numb the throat using an anesthetic spray if necessary.

In a direct fibre-optic laryngoscopy, also known as a flexible laryngoscopy, a flexible tube with a lens on the end is threaded up the nose and down the throat. Often a decongestant and a numbing spray are used to minimise discomfort. Indirect and direct fibre-optic laryngoscopies do not take very long, sometimes as little as ten minutes.

However, a direct laryngoscopy, in which the tongue is pushed down and the epiglottis lifted up, can take up to 45 minutes and is usually performed under general anesthetic. A direct laryngoscopy can be used if the doctor needs to obtain a tissue sample or remove a small growth. 6

Treatment for long-lasting laryngitis depends on the source of the issue. If the laryngitis is caused by gastric reflux, that underlying condition should be treated. If the inflammation is caused by a bacterial infection, antibiotic medications are normally taken.

Aside from addressing the root cause with appropriate medications and/or therapies, treatment for persistent laryngitis mainly involves resting the voice and soothing the throat, to give the larynx and vocal cords a chance to heal. Self-care remedies that may be helpful include:

• Giving up tobacco products, especially smoking, which can dry out the throat and vocal cords.
• Choosing non-caffeinated, non-alcoholic beverages, which can dehydrate the body, aggravating laryngeal symptoms.
• Drinking plenty of water, to thin mucus in the throat, so that it clears easily. This decreases congestion and helps minimise the need to cough.
• Using natural products that fight infection, like ginger and turmeric extracts. These can be added to hot drinks, can reduce the need to cough and help fight infection.
• Keeping clean, by using antibacterial handwashes and wipes at regular intervals throughout the day, particularly after coughing. This will also help prevent the transmission of laryngeal infection to others.
• Avoiding breathing in fumes from smoke or household chemicals, which can cause vocal cord irritation.

Prevention can be achieved by treatment of a gastric reflux condition, avoidance of smoking and smoke exposure, and moderate use of the voice.

• Infectious or allergic chronic laryngitis
• Reflux laryngitis
• Chronic inflammation of the larynx

Q: Can chronic laryngitis indicate cancer?
A: Although hoarseness that lasts three weeks or more can be a sign of laryngeal cancer, it is much more likely to be caused by something else. Other potential causes of laryngitis include postnasal drip, allergies, GERD or even thyroid problems. However, if prolonged hoarseness accompanies one or more of the symptoms listed below, the affected person should seek medical assistance: 7 8

• A sore throat that does not respond to treatment
• Constant coughing
• Shortness of breath
• Difficulty or pain when swallowing
• Ear pain
• Difficult or noisy breathing
• Feeling of a lump in the throat
• A mass in the neck
• Halitosis, or persistent bad breath

If you are concerned about cancer or laryngitis in yourself or a loved one, you can do a free symptom assessment using the Ada app at any time.

Q: How can a person affected by chronic laryngitis get their voice back?
A: Soothing and resting the vocal cords is key for people affected by chronic laryngitis. To do this, affected people should: 3

• Stay well-hydratedQuit smoking and avoid secondhand tobacco smoke
• Keep alcohol consumption to a minimum and preferably cease to drink alcohol entirely and even avoid using alcohol-based mouthwashes
• Avoid using medication that dries out the mucus membranes
• Use a humidifier in dry weather or dry climates
• Maintain a healthy diet

Q: How long does chronic laryngitis last?
A: The exact duration for which chronic laryngitis lasts depends on the underlying cause and whether it is being treated. However, it is generally agreed that to be categorized as chronic laryngitis, the condition must last for three weeks or more.

Q: Is chronic laryngitis contagious?
A: Chronic laryngitis itself is not contagious, but some of the underlying bacterial or viral causes may be.

Q: Can vaping cause chronic laryngitis?
A: Yes, vaping can cause chronic laryngitis, in much the same way that traditional smoking, i.e. using a pipe or cigarettes, does.