Laryngitis

by , last modified on 1/25/14
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This section will go over what laryngitis looks like. "Laryngitis" is often a term used in a very loose sense, almost synonymously and interchangeably with hoarseness. However, laryngitis, at least as it pertains to examples in this section, is specifically defined as inflammation or infection of the larynx that results in hoarseness. Indeed, not all hoarseness is due to laryngitis. Treatment depends on the cause. Laryngitis due to reflux is treated with a proton-pump inhibitor (prilosec, nexium, protonix, etc) medication. Laryngitis due to infection is treated with antibiotics. Laryngitis due to trauma is treated with voice rest and steroids. Laryngitis due to viral upper respiratory illness is treated symptommatically and may include mucinex, hydration, voice rest, steroids, etc. Some people complain of a chronic cough after a viral illness which is treated differently.

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Click here for audio & video of what normal looks like.
Photos displaying abnormalities can be found in the Photo Library.

How Were These Images/Videos Obtained??? By a Procedure Called Fiberoptic Trans-Nasal Endoscopy...

Example 1: Traumatic Laryngitis

Audio - Standard Passage

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The patient was struck in the throat that resulted in immediate hoarseness. The recordings shown here are after 4 days of high dose steroids and voice rest. Note the low pitch of the voice. That's due to the edematous vocal cords. Remember, vocal cords are just like the strings of a violin where the high pitch string is thin and the lower pitch string is thick. Also note the inflamed (red) appearance of the vocal cords. One can also see reflux mucus spilling over into the back part of the vocal cords.

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traumatic

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Example 2: Candidiasis of the Larynx

Audio - Standard Passage

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Note the white splotches throughout the voice box, including the true vocal cords. Treatment was accomplished with diflucan. He incidentally has significant lateral squeeze of his false vocal cords on phonation to the point of obscuring his true vocal cords; aka plicae ventricularis.

This disorder is most common in asthmatics who use steroid inhalers daily (ie, advair).

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candida

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Example 3: Hemorrhagic Laryngitis

Audio - Standard Passage

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Patient suddenly lost his voice 3 days prior to this examination after coughing vigorously. Though his voice did recover somewhat, note the raspiness. Examination revealed a bright red left true vocal cord, likely secondary to a burst blood vessel triggered by the strong cough. Treatment was steroids and strict voice rest.

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laryngitis

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Example 4: Reflux Laryngitis

Audio-"Happy Birthday"

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This patient has a raspy voice with a somewhat gurgly quality to it, especially in the lower registers. He also suffered from chronic throat-clearing and a phlegmy throat. The patient also denied any heartburn and other sensations that would make him think of reflux as a cause (he actually erroneously blamed post-nasal drainage). Moreover, the examination provided here is after several months on twice a day proton pump inhibitor plus zantac at night. In spite of this intense medical therapy, note the bubbly mucus (reflux) welling up on the video, especially on the top your-right hand of the screen (patient's left pyriform sinus). At the end of the video clip, the reflux is about to spill-over into his voicebox. The patient does have severe laryngopharyngeal reflux (LPR, GERD) which ultimately was found to be non-acidic in nature. A referral was made to GI.

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lpr

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Example 5: Viral Laryngitis

Audio-Standard Passage

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This patient has a raspy voice with a significantly lower baseline pitch than normal. Patient coincidentally suffered from an upper respiratory infection. Note in the video that his vocal cords are quite edematous. Much like a violin string, the thicker the string (vocal cord), the deeper the pitch. The absence of any purulence and significant inflammation argues against a bacterial laryngitis. Treatment for this patient consisted of voice rest, steroids, hydration, and mucinex.

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viral

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Example 6: Bacterial Laryngitis

Audio-Standard Passage

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This patient has a severe raspy voice with a significantly lower baseline pitch than normal. On examination shown in the video, note the thickened vocal cords with cobblestoned surface. Thick, green mucus can be seen as well in the front and back of the voicebox indicating a bacterial infection of the voicebox. Successful treatment was accomplished with antibiotics, steroids, mucinex, and voice rest.

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bacterial

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Example 7: Allergic Laryngitis

Pending.

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