Sore throat – Laryngitis
Laryngitis is inflammation of the larynx (voice box). In most cases, it will get better without treatment in about a week.
Symptoms of laryngitis include:
loss of voice
As laryngitis often gets better quickly without treatment, you normally only need to see your GP if the symptoms are particularly severe or they last longer than three weeks.
Why it happens
In most cases, laryngitis is caused by a viral infection (such as a cold), or straining your voice. In these cases, most of the symptoms will usually pass within a week. This is known as acute laryngitis.
Laryngitis can occasionally have other causes, such as smoking, alcohol misuse or an allergic reaction, and the symptoms can last much longer. This is known as chronic laryngitis.
How laryngitis is treated
Most cases of laryngitis get better without treatment within a week. To help your vocal cords heal, it is important not to smoke, to avoid smoky environments, drink plenty of fluids (particularly water) and try to rest your voice as much as possible.
In some cases, it may be possible to treat the underlying cause of laryngitis. For example, if the symptoms are due to an allergic reaction, you may be able avoid the substance you are allergic to, or take medication to help control your body's response to the substance.
Can laryngitis be prevented?
It's not always possible to prevent laryngitis, as it is often caused by common infections like cold and flu that are difficult to avoid. If advised by your GP, however, having the annual flu vaccine can help reduce your risk.
There are also a number of other things you can do to help reduce your chances of developing the condition. For example, you can avoid straining your voice, avoid smoking and ensure you don't drink more than the recommended limits of alcohol consumptio
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The larynx, or voice box, is a tube-like structure found at the entrance of the windpipe (trachea). The lump at the front of your throat, commonly known as the Adam’s apple, is your larynx.
The larynx has three main functions:
it helps channel oxygen into your windpipe when you breathe
it acts like a valve, closing off the windpipe when you swallow to prevent food or liquid entering your airways
it contains the vocal cords which vibrate as air passes through them, producing the sound of your voice
Symptoms of laryngitis
Symptoms of laryngitis can begin suddenly and usually get worse over a period of two to three days. After this time, your symptoms should improve and you will usually feel much better within a week.
Occasionally, the symptoms develop more slowly and last for weeks or even months.
Common symptoms of laryngitis include:
a constant need to clear your throat
The hoarse voice and speaking difficulties associated with laryngitis usually get worse over the course of each day that you are ill and they may last for up to a week after the other symptoms have gone.
In a few cases, the larynx can swell and cause breathing difficulties. This is not common in adults but can occur in young children who have smaller, narrower windpipes.
Laryngitis is often linked to another illness, such as a cold, flu, throat infection (pharyngitis) or tonsillitis.
Therefore, you may also experience other symptoms caused by these illnesses, such as a headache, swollen glands in the neck, runny nose, pain when swallowing and feeling tired and achy.
When to seek medical help
Laryngitis often gets better on its own without treatment, so you don't usually need to see your GP if you think you have the condition.
However, you should see your GP if the symptoms are particularly severe or last longer than three weeks.
You should seek immediate medical help if you or your child experience breathing difficulties.
Causes of laryngitis
Laryngitis occurs when the larynx (voice box) becomes irritated and swollen. It's mostly caused by an infection or damage to the larynx.
Viral infections such as the common cold and flu are the most common type of infection associated with acute laryngitis.
Rarer types of infection include:
bacterial infections, such as diphtheria
fungal infections, such as thrush (candidiasis) or aspergillosis
People with weakened immune systems, due to conditions such as HIV or as a result of chemotherapy or steroid medication, are thought to be most at risk from fungal laryngitis.
Laryngitis caused by a viral, bacterial or fungal infection is known as infectious laryngitis.
Damage to the larynx
Laryngitis is also often caused by straining your voice, such as speaking or singing for long periods or shouting and singing loudly.
Straining your voice can cause your vocal cords to vibrate at a faster rate than they should. This excessive vibration can damage the surface of your vocal cords, causing them to become inflamed.
Laryngitis caused by damage to the larynx is known as mechanical laryngitis.
Less common causes of mechanical laryngitis include:
direct trauma to the larynx - such as a blow to your throat, an accident or a sports injury
persistent and frequent clearing of your throat
As well as infection and damage to the larynx, laryngitis can also be caused by:
smoking and alcohol misuse, which can dry out and irritate your larynx
gastro-oesophageal reflux disease (GORD) - when stomach acid leaks out of the stomach and up into the throat, where it can irritate your larynx
allergic reactions to substances such as dust, fumes, chemicals and toxins
These causes are most often associated with long-term (chronic) laryngitis.
Laryngitis will often get better without treatment, so you don't usually need to see your GP unless you have particularly severe or long-lasting symptoms.
If you see your GP with laryngitis, theywill discuss with you what could be causing the condition, including:
overusing your voice
Your GP may refer you for blood tests and take a small tissue sample from your throat using a swab (a small cotton bud on a plastic shaft). This is to check for a possible viral, bacterial or fungal infection.
They may also examine your larynx using a mirror to look for redness or swelling.
Seeing a specialist
If your GP thinks you need to see a specialist, they may refer you to an ear, nose and throat (ENT) specialist for some of the tests described below.
A laryngoscopy is a test that involves examining your larynx using a thin tube containing a camera and light source (endoscope), which can be passed into your throat through either your nose or mouth. This test allows your doctor to assess any damage to your larynx.
Laryngoscopies carried out through the nose are not painful, but it can be uncomfortable and the tube may trigger your gag reflex, which can make you feel like you want to be sick (but it is highly unlikely that you will be sick). Local anaesthetic can be used to numb your nose and throat, which should help reduce these sensations.
If you are having persistent problems with your voice, you might be asked to talk or sing while your larynx is examined. This may help you doctor determine why you are having problems with your voice.
For laryngoscopies carried out through the mouth, general anaesthetic is used. This means you will be asleep during the examination. You can usually go home on the day you have this procedure, although an overnight stay in hospital is sometimes recommended.
Testing for laryngeal cancer
Your ENT specialist may also want to make sure your symptoms are not the result of laryngeal cancer.
Laryngeal cancer is uncommon, but it is important to confirm it or rule it out quickly because the sooner laryngeal cancer is diagnosed, the more effective treatment will be.
Tests your ENT specialist may recommend to check for laryngeal cancer include:
computerised tomography (CT) scan - a series of X-rays are taken and assembled by a computer into a more detailed ‘3D’ image of your throat
magnetic resonance imaging (MRI) scan - strong magnetic fields and radio waves are used to produce detailed scans of the inside of your throat
biopsy - where a sample of tissue is taken during a laryngoscopy to check for the presence of cancerous cells
Other tests that may also be carried out include:
a skin allergy test to check whether you have an allergy to certain substances
chest and neck X-ray to check for any abnormalities, such as an unusual narrowing or swelling of your larynx
In most cases, laryngitis gets better within a week without treatment.
However, there are a number of things you can do to help your recovery, including:
don't smoke and avoid smoky, dry or dusty environments
drink plenty of fluids, particularly water (but avoid alcohol and caffeinated drinks), even though swallowing may be painful - this will ensure that you don't get dehydrated
painkillers, such as paracetamol or ibuprofen, may ease any associated pain, headaches and fever (children under the age of 16 shouldn't take aspirin)
gargling with a mouthwash of warm, salty water or an over-the-counter solution, or sucking lozenges, can help soothe a sore throat although they will not reach the larynx
menthol inhalation and air humidifiers may soothe your airways and help keep them clear
avoid speaking when possible and only speak softly when you need to, but don't whisper because this can put more strain on your larynx
See your GP if your symptoms haven't improved after three weeks.
Treating underlying causes
In some cases, it's possible to treat the underlying cause of laryngitis, such as:
bacterial infections (but not viral infections) can be treated with antibiotics
if smoking or alcohol misuse is causing laryngitis, stopping smoking or cutting down how much you drink can help
gastro-oesophageal reflux disease (GORD) can be treated with medication to reduce the amount of acid your stomach produces - see treating GORD for more information
if an allergy is causing laryngitis, you may be able to avoid the substance you're allergic to or take medication called antihistamines to control your body's response to the substance - see treating allergies for more information
if straining your voice is causing laryngitis, you may benefit from vocal therapy (see below)
Vocal therapy is a type of speech and language therapy that involves studying how you use your voice and looking at how this may contribute to your symptoms. This means you can be given information and advice about any changes you can make or voice exercises you can do to prevent further damage to your larynx.
As laryngitis is often caused by common viral infections, such as cold and flu, it is not always possible to prevent it.
However, there are things you can do to reduce your risk of developing the condition, including:
practising good personal hygiene, such as washing your hands before and after eating and after using the toilet
avoiding people who are ill, particularly if you are prone to laryngitis
avoiding irritants, such as smoke or dust, particularly if you have a cold or other respiratory tract infection
not drinking more than the recommended limits of alcohol consumption
not regularly clearing your throat, as this can irritate the larynx (try swallowing instead)
raising your head off your bed with pillows when you are sleeping to protect your larynx from any acid reflux from your stomach during sleep
not shouting or singing loudly or for long periods of time - it's important for people who regularly use their voice excessively to receive proper training so they do not damage their larynx
making sure you have the annual flu vaccine if recommended by your GP