Diagnosis of Laryngitis

Key Glossary Terms

Laryngitis
Inflammation of the voice box (larynx); can result from many causes; specific cause needs to be identified for correct diagnosis and proper treatment plan

Inflammation
Response to injury that results in swelling, redness, and/or pain

Glossary

Laryngitis is diagnosed by examination of the larynx. The laryngeal examination may include a mirror examination or specialized magnified viewing of the voice box (rigid laryngoscopy or laryngeal stroboscopy). (For more information, see Laryngoscopy/Stroboscopy.)

The following are investigated during laryngoscopy:

• Area with inflammation
• Clues to possible cause(s) of laryngitis
• Other voice box lesions or problems already present in addition to laryngitis

• Stroboscopy is a procedure that enables an assessment of the vibratory function of the vocal folds. Alterations in vocal fold vibration may result from the swelling or from vocal fold lesions that may be present. (For more information, see Laryngoscopy/Stroboscopy.)
• Often, laryngitis can make symptoms quite noticeable; for instance, a patient with laryngitis may be prompted to seek medical care for a vocal fold lesion that was already present (but not noticed).

On laryngeal examination, laryngitis appears as redness and/or swelling of the larynx. This swelling may occur throughout the larynx (diffuse) or may occur only on the vocal folds or in the back of the larynx. Typical patterns of laryngitis are:

• Diffuse (widespread) swelling: Usually the result of an inhaled cause of laryngitis, such as smoke or an air pollutant.
• Swelling limited to vocal folds: Usually occurs due to mechanical causes of laryngitis, such as vocal misuse or overuse.
• Swelling in the back of the voice box (larynx): Also known as posterior laryngitis, occurs most commonly with backflow of stomach fluids to the throat and voice box area (laryngopharyngeal reflux (LPR)).

General guidelines:

• More than one factor may cause laryngitis.
• Laryngitis is a general term describing an area of inflammation; the cause of the laryngitis needs to be identified before a complete medical diagnosis can be offered.
• The identification of the cause of laryngitis and other associated problems is required to determine optimal therapy and to maximize healing results.

• The exact role of allergies in patients with voice disorders is highly controversial.
• Some otolaryngologists with a very strong orientation to and interest in allergic disease believe that the majority of voice problems are caused by either environmental or food allergies.
• However, environmental allergies are extremely common, such that any patient with a voice problem may also have mild to moderate environmental allergies.
• A direct connection of a voice problem to a coexisting allergy problem has not been strongly and convincingly made in a majority of patients with voice problems. Patients with voice problems should be examined carefully with high-quality laryngeal examination, review of the patient's symptoms, and allergy evaluation if indicated.

• The role of laryngopharyngeal reflux disease (LPR) in laryngitis specifically and in voice disorders in general is highly controversial.
• Many otolaryngologists and laryngologists believe that a high degree of a patient's primary voice disorder comes from unsuspected and subtle laryngitis due to gastric acid reflux. However, other otolaryngologists and laryngologists believe that LPR is not as prevalent in the field of voice disorders.
• One reason for this controversy is the difficulty in making a definitive diagnosis of LPR. (For more information, see Reflux Laryngitis.)

Red Flag

"Chronic Laryngitis" Is a Vague Term – specific cause needs to be identified to arrive at diagnosis and determine appropriate treatment

Chronic laryngitis, without identification of a cause, is not a specific diagnosis. A patient diagnosed with chronic laryngitis should ask the otolaryngologist to identify the underlying cause of the chronic laryngitis.

Most otolaryngologists avoid the term "chronic laryngitis" since it has no specific meaning and thus does not provide helpful information to the patient or other physicians.