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__NOTOC__
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{{Laryngitis}}
{{Laryngitis}}
{{CMG}}; {{AE}} {{chetan}}, {{Alonso}}
{{CMG}}; {{AE}} {{chetan}}, {{Alonso}}, {{AG}}


==Overview==
==Overview==
[[Laryngitis]] is caused by [[viral]], [[gastroesophageal reflux]], bacterial or fungal infection or [[vocal cord nodules]]. Correct treatment depends on a correct diagnosis of the underlying cause of laryngitis. [[NSAID]] may help alleviate pain and fever associated with laryngitis. Symptomatic treatment includes advising not to speak, nasal breathing, humidifiers, salt water gargles, ginger tea and steroids. [[Antibiotics]] or [[antifungal]] medication should be used if an infectious cause is assumed. Ultimately, surgery with speech therapy may be recommended.
There is no treatment for viral laryngitis; the mainstay of therapy is supportive care. The mainstay of therapy for infectious causes of laryngitis is antimicrobial therapy. Medical therapy for laryngitis due to [[gastroesophageal reflux]] includes acid suppression therapy such as either [[omeprazole]] or [[ranitidine]].  


==Medical Therapy==
==Medical Therapy==
===Viral laryngitis===
*There is no treatment for viral laryngitis; the mainstay of therapy is supportive care.
*[[Ibuprofen]] and [[aspirin]] may help alleviate fever and some of the discomfort associated with laryngitis.
*Patients are advised to avoid [[Speech communication|speaking]] when possible. They are instructed to speak softly, but to avoid whispering, which further strains the voice.<ref name=Mayo> Laryngitis. Mayo Clinic (2015). http://www.mayoclinic.org/diseases-conditions/laryngitis/basics/lifestyle-home-remedies/con-20021565 Accessed on November 2, 2016</ref>
*Throat clearing is not advised. The act of clearing one's throat may aggravate the laryngitis.
*Humidifiers and warm showers can also help alleviate some symptoms.
*[[Steroids]] may be prescribed to help accelerate the healing if significant inflammation is present.


Correct treatment depends on a correct diagnosis of the underlying cause of laryngitis. The most prevalent cause of a missed diagnosis of laryngeal [[cancer]] is a belief that persistent hoarseness is due to laryngitis. Should hoarseness last for more than 3 weeks, one should consult an otolaryngologist (ear, nose, and throat physician) for an examination including direct visualization of the vocal cords. This examination may also detect the presence of [[vocal fold nodules|vocal cord nodules]], a structural change resulting in persistent hoarseness or loss of voice.
===Gastroesophageal reflux laryngitis===
*The mainstay of therapy for [[gastroesophageal reflux]] laryngitis is an [[H2 antagonist]] (e.g.: [[ranitidine]]) or a [[proton-pump inhibitor]] (PPI) (e.g.: [[omeprazole]], [[esomeprazole]], [[pantoprazole]]). These drugs may be prescribed for a period between 4-6 weeks.


If laryngitis is due to a viral cause:
===Bacterial laryngitis===
 
*The patient may be prescribed a course of antibiotics however, there is little evidence to demonstrates the efficacy of oral antibiotics for laryngitis.
* [[Ibuprofen]] and [[aspirin]] may help alleviate fever and some of the discomfort associated with laryngitis.
* Patients are advised to avoid [[Speech communication|speaking]] when possible.  They are instructed to speak softly, but to avoid whispering, which further strains the voice.<ref>Mayoclinic.com.  2006.  [http://www.mayoclinic.com/health/laryngitis/DS00366/DSECTION=9 Laryngitis: Self care]</ref>
* [[Nasal breathing]] is very important so as not to dry the [[throat]].
* Throat clearing is very bad. The act of clearing one's throat is very stressful and may aggravate the laryngitis.
* Humidifiers and warm showers can also help alleviate some symptoms.
* Airborne irritants such as smoke and allergens may exacerbate the condition.
* Gargling with a salt water rinse is suggested. Mouth rinses containing [[alcohol]] can dry the throat and may exacerbate a viral case of laryngitis. However, these can be helpful when the cause of the infection is bacterial.
* A tea of [[ginger]] may help reduce swelling of the vocal cords and relieve symptoms.
* [[Steroid]] medications may be prescribed to help accelerate the healing of the inflammation present.
 
If laryngitis is due to [[gastroesophageal reflux]]:
 
* The patient may be instructed to take a nonprescription medication such as Zantac or Prilosec for a period of 4-6 weeks.
 
If laryngitis is due to a bacterial or fungal infection:
* The patient may be prescribed a course of antibiotics or anti-fungal medication.
 
If persistent hoarseness or loss of voice is a result of [[vocal fold nodules|vocal cord nodules]]:
* Physicians may recommend a course of treatment that may include a surgical procedure and/or speech therapy.
* Reduction of high-impact stress to the vocal cords caused by loud, frequent, and rapid speech is recommended.


===Antibiotic Therapy===
===Antibiotic Therapy===
 
* Antibiotic use is not associated with significant improvement of objective symptoms<ref name="Reveiz-2005">{{Cite journal  | last1 = Reveiz | first1 = L. | last2 = Cardona | first2 = AF. | last3 = Ospina | first3 = EG. | title = Antibiotics for acute laryngitis in adults. | journal = Cochrane Database Syst Rev | volume = | issue = 1 | pages = CD004783 | month = | year = 2005 | doi = 10.1002/14651858.CD004783.pub2 | PMID = 15674965 }}</ref><ref name="Reveiz-2007">{{Cite journal  | last1 = Reveiz | first1 = L. | last2 = Cardona | first2 = AF. | last3 = Ospina | first3 = EG. | title = Antibiotics for acute laryngitis in adults. | journal = Cochrane Database Syst Rev | volume =  | issue = 2 | pages = CD004783 | month =  | year = 2007 | doi = 10.1002/14651858.CD004783.pub3 | PMID = 17443555 }}</ref><ref name="Reveiz-2013">{{Cite journal  | last1 = Reveiz | first1 = L. | last2 = Cardona | first2 = AF. | title = Antibiotics for acute laryngitis in adults. | journal = Cochrane Database Syst Rev | volume = 3 | issue = | pages = CD004783 | month =  | year = 2013 | doi = 10.1002/14651858.CD004783.pub4 | PMID = 23543536 }}</ref><ref name="pmid26002823">{{cite journal| author=Reveiz L, Cardona AF| title=Antibiotics for acute laryngitis in adults. | journal=Cochrane Database Syst Rev | year= 2015 | volume=  | issue= 5 | pages= CD004783 | pmid=26002823 | doi=10.1002/14651858.CD004783.pub5 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26002823  }} </ref> and is not a first-line therapy for the treatment of acute laryngitis.<ref name="Schwartz-2009">{{Cite journal  | last1 = Schwartz | first1 = SR. | last2 = Cohen | first2 = SM. | last3 = Dailey | first3 = SH. | last4 = Rosenfeld | first4 = RM. | last5 = Deutsch | first5 = ES. | last6 = Gillespie | first6 = MB. | last7 = Granieri | first7 = E. | last8 = Hapner | first8 = ER. | last9 = Kimball | first9 = CE. | title = Clinical practice guideline: hoarseness (dysphonia). | journal = Otolaryngol Head Neck Surg | volume = 141 | issue = 3 Suppl 2 | pages = S1-S31 | month = Sep | year = 2009 | doi = 10.1016/j.otohns.2009.06.744 | PMID = 19729111 }}</ref>
Antibiotic use in the treatment of acute laryngitis is not supported by current guidelines<ref name="Schwartz-2009">{{Cite journal  | last1 = Schwartz | first1 = SR. | last2 = Cohen | first2 = SM. | last3 = Dailey | first3 = SH. | last4 = Rosenfeld | first4 = RM. | last5 = Deutsch | first5 = ES. | last6 = Gillespie | first6 = MB. | last7 = Granieri | first7 = E. | last8 = Hapner | first8 = ER. | last9 = Kimball | first9 = CE. | title = Clinical practice guideline: hoarseness (dysphonia). | journal = Otolaryngol Head Neck Surg | volume = 141 | issue = 3 Suppl 2 | pages = S1-S31 | month = Sep | year = 2009 | doi = 10.1016/j.otohns.2009.06.744 | PMID = 19729111 }}</ref> and is not associated with a significant difference in objective symptoms based on the meta-analyses.<ref name="Reveiz-2005">{{Cite journal  | last1 = Reveiz | first1 = L. | last2 = Cardona | first2 = AF. | last3 = Ospina | first3 = EG. | title = Antibiotics for acute laryngitis in adults. | journal = Cochrane Database Syst Rev | volume =  | issue = 1 | pages = CD004783 | month =  | year = 2005 | doi = 10.1002/14651858.CD004783.pub2 | PMID = 15674965 }}</ref><ref name="Reveiz-2007">{{Cite journal  | last1 = Reveiz | first1 = L. | last2 = Cardona | first2 = AF. | last3 = Ospina | first3 = EG. | title = Antibiotics for acute laryngitis in adults. | journal = Cochrane Database Syst Rev | volume = | issue = 2 | pages = CD004783 | month =  | year = 2007 | doi = 10.1002/14651858.CD004783.pub3 | PMID = 17443555 }}</ref><ref name="Reveiz-2013">{{Cite journal  | last1 = Reveiz | first1 = L. | last2 = Cardona | first2 = AF. | title = Antibiotics for acute laryngitis in adults. | journal = Cochrane Database Syst Rev | volume = 3 | issue = | pages = CD004783 | month = | year = 2013 | doi = 10.1002/14651858.CD004783.pub4 | PMID = 23543536 }}</ref>
*[[Fusafungine]], a locally acting antibiotic, has been shown to increase the number of asymptomatic patients by the fifth day of disease.<ref name="pmid15626253">{{cite journal| author=Lund VJ, Grouin JM, Eccles R, Bouter C, Chabolle F| title=Efficacy of fusafungine in acute rhinopharyngitis: a pooled analysis. | journal=Rhinology | year= 2004 | volume= 42 | issue= 4 | pages= 207-12 | pmid=15626253 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15626253  }} </ref>


==References==
==References==
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{{reflist|2}}


[[Category:Emergency mdicine]]
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[[Category:Infectious disease]]
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[[Category:Otolaryngologic Disease]]
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[[Category:Otolaryngology]]
[[Category:Pulmonology]]
[[Category:Gynecology]]
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Latest revision as of 22:29, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Chetan Lokhande, M.B.B.S [2], Alonso Alvarado, M.D. [3], Anthony Gallo, B.S. [4]

Overview

There is no treatment for viral laryngitis; the mainstay of therapy is supportive care. The mainstay of therapy for infectious causes of laryngitis is antimicrobial therapy. Medical therapy for laryngitis due to gastroesophageal reflux includes acid suppression therapy such as either omeprazole or ranitidine.

Medical Therapy

Viral laryngitis

  • There is no treatment for viral laryngitis; the mainstay of therapy is supportive care.
  • Ibuprofen and aspirin may help alleviate fever and some of the discomfort associated with laryngitis.
  • Patients are advised to avoid speaking when possible. They are instructed to speak softly, but to avoid whispering, which further strains the voice.[1]
  • Throat clearing is not advised. The act of clearing one's throat may aggravate the laryngitis.
  • Humidifiers and warm showers can also help alleviate some symptoms.
  • Steroids may be prescribed to help accelerate the healing if significant inflammation is present.

Gastroesophageal reflux laryngitis

Bacterial laryngitis

  • The patient may be prescribed a course of antibiotics however, there is little evidence to demonstrates the efficacy of oral antibiotics for laryngitis.

Antibiotic Therapy

  • Antibiotic use is not associated with significant improvement of objective symptoms[2][3][4][5] and is not a first-line therapy for the treatment of acute laryngitis.[6]
  • Fusafungine, a locally acting antibiotic, has been shown to increase the number of asymptomatic patients by the fifth day of disease.[7]

References

  1. ↑ Laryngitis. Mayo Clinic (2015). http://www.mayoclinic.org/diseases-conditions/laryngitis/basics/lifestyle-home-remedies/con-20021565 Accessed on November 2, 2016
  2. ↑ Reveiz, L.; Cardona, AF.; Ospina, EG. (2005). "Antibiotics for acute laryngitis in adults". Cochrane Database Syst Rev (1): CD004783. doi:10.1002/14651858.CD004783.pub2. PMID 15674965.
  3. ↑ Reveiz, L.; Cardona, AF.; Ospina, EG. (2007). "Antibiotics for acute laryngitis in adults". Cochrane Database Syst Rev (2): CD004783. doi:10.1002/14651858.CD004783.pub3. PMID 17443555.
  4. ↑ Reveiz, L.; Cardona, AF. (2013). "Antibiotics for acute laryngitis in adults". Cochrane Database Syst Rev. 3: CD004783. doi:10.1002/14651858.CD004783.pub4. PMID 23543536.
  5. ↑ Reveiz L, Cardona AF (2015). "Antibiotics for acute laryngitis in adults". Cochrane Database Syst Rev (5): CD004783. doi:10.1002/14651858.CD004783.pub5. PMID 26002823.
  6. ↑ Schwartz, SR.; Cohen, SM.; Dailey, SH.; Rosenfeld, RM.; Deutsch, ES.; Gillespie, MB.; Granieri, E.; Hapner, ER.; Kimball, CE. (2009). "Clinical practice guideline: hoarseness (dysphonia)". Otolaryngol Head Neck Surg. 141 (3 Suppl 2): S1–S31. doi:10.1016/j.otohns.2009.06.744. PMID 19729111. Unknown parameter |month= ignored (help)
  7. ↑ Lund VJ, Grouin JM, Eccles R, Bouter C, Chabolle F (2004). "Efficacy of fusafungine in acute rhinopharyngitis: a pooled analysis". Rhinology. 42 (4): 207–12. PMID 15626253.
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