Laryngitis

Laryngitis is inflammation of the larynx (voice box). In most cases, it gets better without treatment in about a week.

Symptoms of laryngitis can begin suddenly and usually get worse over a period of two to three days. Common symptoms of laryngitis include:

• hoarseness
• difficulty speaking
• sore throat
• mild fever
• irritating cough
• a constant need to clear your throat

The hoarse voice and speaking difficulties usually get worse each day you're ill and 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 isn't 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, so you might also have other symptoms such as:

• a headache
• swollen glands
• runny nose
• pain when swallowing
• feeling tired and achy

When to seek medical help

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 two weeks.

You should seek immediate medical help if you or your child experience breathing difficulties.

If you see your GP, they'll discuss the possible causes with you and may refer you for tests or to a specialist in hospital.

Read more about diagnosing laryngitis

Why it happens

In most cases, laryngitis is caused by either: 

• a viral infection – such as a cold or flu, or 
• damage to your larynx – usually by straining your voice

In these cases, most of the symptoms 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.

Read more about the causes of laryngitis

How laryngitis is treated

Most cases of laryngitis get better without treatment within a week. To help your vocal cords heal, it's 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 caused by an allergic reaction, you may be able avoid the substance you're allergic to, or take medication to help control your body's response to the substance.

Read more about treating laryngitis

Can laryngitis be prevented?

As laryngitis is often caused by a common viral infection, such as a cold or flu, it's not always possible to prevent it.

However, you can reduce your risk of developing the condition by:

• making sure you have the annual flu vaccine (if recommended by your GP)
• practising good personal hygiene  – such as washing your hands before and after eating and after using the toilet
• avoiding close contact with people who have respiratory infections, such as a cold or flu – particularly if you're prone to laryngitis
• avoiding irritants, such as smoke or dust – particularly if you have a cold or other respiratory tract infection
• not smoking
• 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 with pillows when you're 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 don't damage their larynx

Laryngitis occurs when the larynx (voice box) becomes irritated and swollen. It's usually caused by an infection or damage to the larynx.

Infection

Viral infections such as a cold or 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, caused by 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
• prolonged coughing
• persistent and frequent clearing of your throat

Other causes

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 your stomach and up into your 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 often gets 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, they'll discuss with you what could be causing the condition, including:

• overusing your voice
• smoking
• misusing alcohol
• allergies

Your GP may refer you for blood tests and take a throat swab using 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.

Laryngoscopy

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 (it's highly unlikely that you actually will be sick). Local anaesthetic can be used to numb your nose and throat, which should help reduce these feelings.

If you're having persistent problems with your voice, you might be asked to talk or sing while your larynx is examined. This may help your doctor determine why you're having problems with your voice.

For laryngoscopies carried out through the mouth, general anaesthetic is used. This means you'll be asleep during the examination. You can often 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 aren't the result of laryngeal cancer. 

Alcohol and tobacco are the two main things that can increase your risk of developing laryngeal cancer. The more you drink or smoke, the higher your risk of developing laryngeal cancer.

Laryngeal cancer is uncommon, but it's 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

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. See your GP if your symptoms are severe or haven't improved after two weeks.

Treatment at home

You may be able to help your recovery by:

• not smoking and avoiding smoky, dry or dusty environments
• drinking plenty of fluids to avoid dehydration – particularly water (avoid alcohol and caffeinated drinks), even though swallowing may be painful
• taking painkillers, such as paracetamol or ibuprofen – which 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 – this may help to soothe a sore throat
• using menthol inhalation and air humidifiers – which may soothe your airways and help keep them clear
• avoiding speaking when possible and only speaking softly when you need to – but don't whisper because this can put more strain on your larynx

Treating underlying causes

In some cases, it's possible to treat the underlying cause of laryngitis. For example:

• 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 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 how this may contribute to your symptoms. You may be given information and advice about any changes you can make or voice exercises you can do to prevent further damage to your larynx.