Chronic laryngitis

1. Chronic laryngitis
Definition & aetiology : Chronic laryngitis is chronic inflammation of the laryngeal structures, most
commonly the laryngeal mucosa. The inflammatory process can be either infectious or non-
infectious, with a broad spectrum of aetiologies ranging from nonspecific diffuse hyperplastic
laryngitis associated with various irritants such as smoking or voice abuse to extremely rare infective
conditions such as histoplasmosis.
Aetiology
Upper & lower respiratory tract infection;
Occupation with excess noise,asbestos workers, cement workers, shoe workers, hairdressing.
Highly significant with age& smoking;
Allergy
Gastro-oesophageal reflex;
Aetiology of chronic laryngitis is frequently multifactorial.
Clinical presentation
Dysphonia (alternation of voice quality).
A sensation of something being in the pharynx.
Difficulty in swallowing (dysphagia)
Painful speaking( odynophonia)
Persistent cough
Throat clearing
Halitosis
Bitter taste
Waterbrush
Otalgia
Operative assessment
The initial outpatient assessment establishes if there are any discrete lesions such as leukoplakia,
nodules, or polyps & if not , whether the diffuse changes are uniform, such as Reinke’s oedema or
non-specific & possibly irregular as in chronic laryngitis. Once the finding have been categorized,
next step stage is either initiation of treatment. Voice therapy by the speech & language therapists,
or further assessment by microlaryngoscopy.

2. Four-point gradation of chronic laryngitis;
Grade
Grade I Mild erythema, stasis of secetions, string sign,
pilling up of inter-arytenoid mucosa.
Grade II Diffuse oedema & mucosal thickening but with
little erythema
Grade III Diffuse erythema, with granular friable mucosa
or ulceration.
Grade IV Discrete granuloma(s) with or without oedema
or erythema.
Histological features of chronic laryngitis
Grade
Grade I Thickened epithelium, hyperkeratosis, regular
maturation retained.
Grade II Cellular atypia, abnormal mitoses
Grade III Severe dysplasia, epithelium has squamous cell
carcinoma but without infiltration through the
basement.
Nonspecific laryngitis
Nonspecific laryngitis is an extremely common condition which may present with a wide spectrum of
signs & symptoms & severity. Patients invariably present with a degree of dysphonia & may have
throat discomfort, awareness in the throat, i.e. globus type symptoms, throat clearing, halitosis.
The most common aetiological factors are smoking, voice abuse, GERD.
There are two theories of GERD.
1.Direct reflex of acid from stomach & oesophagus crossing the upper oesophageal sphincter
& causing an inflammatory effect on laryngopharynx.
2.The indirect theory where chronic repetitive throat clearing & cough is caused by a vagally
mediated response secondary to acid in the lower oesophagus.

3. Treatment
1.Lifestyle changes
Avoiding late evening eating & drinking;
Reducing evening alcohol intake
Avoiding foodstuffs giving reflux symptoms;
Raising the head of the bed.
2.Antacids;
3.H2 antagonists; ranitidine 150mg twice daily;
4.Proton pump inhitors; omeprazole 20mg twice daily for at least eight weeks;
5.Fundiplication.
Best clinical practice
1.Chronic laryngitis frequently has a multifactorial aetiology.
2.The main aetiological factors are smoking , voice abuse & gastro-oesophageal reflex.
3.Following the clinical diagnosis,treat with proton pump inhibitor, voice therapy & smoking
cessation therapy.
4.Surgery should be used for discrete lesions only.
5.Chronic infectious processes in the larynx are rare & frequently mimic squamous cell
carcinoma.
Treatment in the K.J.Lee
1.Vocal hygiene- absolute silence not advised.
2.Hydration of patients.
3.Decongestant for nasal obstruction
4.Cough suppression
5.Mucolytic
6.Avoid drying antihistamines
7.H2 blockers or proton pump inhibitors if acid reflux detected or suspected.
8.Steroid only for need to use voice (performance). Steroid mask symptoms; therefore,
performer should be monitored closely to detect injury due to overuse.