Acute Laryngitis

Acute laryngitis is inflammation of the larynx and vocal folds lasting less than 3 weeks. Etiology is predominantly viral (rhinovirus, influenza A/B, parainfluenza, RSV, adenovirus, coronaviruses) accounting for 80-90% of cases, with bacterial causes (group A Streptococcus, Mycoplasma, Chlamydophila) less common. Non-infectious causes include vocal misuse/overuse (singers, teachers, sports fans), laryngopharyngeal reflux, environmental irritants (smoke, allergens, chemical fumes), and inhaled corticosteroids in asthma patients (especially fluticasone-induced).

Pathophysiology involves inflammation, edema, and congestion of the vocal fold mucosa with disruption of the lamina propria's mucosal wave, resulting in altered phonation. Examination via laryngoscopy or videostroboscopy shows erythema, edema, increased vascularity, and reduced mucosal wave. Clinical evaluation considers duration (acute <3 weeks vs chronic >3 weeks), risk factors (smoking, alcohol, voice use, reflux), and red flags (persistent hoarseness >3 weeks, hemoptysis, weight loss, neck mass) requiring urgent flexible laryngoscopy.

Most cases resolve spontaneously within 7-14 days with conservative management. Treatment focuses on voice rest (relative voice rest preferred over absolute silence to prevent compensatory hyperfunction), aggressive hydration (3 L water/day), humidification, avoidance of throat clearing and whispering (which strain the larynx), elimination of irritants (smoking, alcohol, caffeine), and treatment of underlying causes (PPI for reflux, antihistamines for allergic etiology). Antibiotics are NOT routinely indicated unless bacterial infection is confirmed. Persistent hoarseness beyond 3 weeks mandates referral to ENT for laryngoscopy to exclude vocal fold lesions or malignancy.