Ep 196 – Acute laryngitis

In this episode, Dr Roger Henderson looks at acute laryngitis, a condition that is both common and deceptively complex. Often dismissed as a simple cold-related voice change, acute laryngitis actually offers GPs insights into airway physiology, vocal mechanics and clinical reasoning. Understanding the nuances of this condition is essential. We look at its typical presentation, from sudden hoarseness and vocal fatigue to dry cough, and discuss red flags that signal more serious pathology. We also consider infectious and non-infectious causes, management strategies and the subtle ways patient behaviour and environment can influence recovery.

Key take-home points

• Acute laryngitis is usually self-limiting, resolving within about 2 weeks.
• Significant dyspnoea, stridor, drooling or severe dysphagia is not typical and should prompt urgent evaluation.
• Viral infections account for the majority of acute laryngitis cases.
• Vocal overuse or misuse can precipitate acute laryngitis even without infection.
• Gastroesophageal reflux can cause acute or episodic voice symptoms without classic heartburn.
• Immunocompromised patients are at higher risk for fungal or atypical laryngeal infections.
• Voice rest is the single most effective intervention in acute laryngitis.
• Flexible laryngoscopy can confirm the diagnosis and rule out structural or neoplastic causes.
• Maladaptive voice behaviours learned during acute inflammation can prolong dysphonia.
• Asthma and inhaled medications may contribute to laryngeal inflammation by mechanical trauma or chemical irritation, particularly with steroid use. Proper inhaler technique and rinsing after use can reduce this risk.
• In children, isolated voice changes under the age of three should prompt evaluation for structural or neurologic disorders, as simple acute laryngitis is uncommon in this group.
• Routine antibiotics are not recommended for healthy adults with acute laryngitis, though high-risk or severely symptomatic patients may need targeted therapy.
• Environmental irritants, including smoke, pollutants and strong fragrances, can trigger or exacerbate laryngeal inflammation. Avoidance of these factors supports faster recovery.
• Fungal laryngitis is rare but should be suspected in immunocompromised patients or those using inhaled corticosteroids; treatment requires confirmation and targeted antifungal therapy.
• Even though acute laryngitis often appears benign, careful history-taking and evaluation are crucial because hoarseness may sometimes signal a more serious underlying condition.

Key references

1. Mazurek H, et al. Adv Respir Med. 2019;87(5):308-316. doi: 10.5603/ARM.2019.0056.
2. Stachler RJ, et al. Otolaryngol Head Neck Surg. 2018;158(1_suppl):S1-S42. doi: 10.1177/0194599817751030.
3. House SA, Fisher EL. Am Fam Physician. 2017;96(11):720-728.
4. Wood, JM, et al. BMJ. 2014;349:g5827. doi: 10.1136/bmj.g5827.
5. Reveiz L, Cardona AF. Cochrane Database Syst Rev. 2015;2015(5):CD004783. doi: 10.1002/14651858.CD004783.pub5.