Laryngitis

Question 1

Definition and causes of laryngitis

Answer 1

Laryngitis/laryngotracheitis = inflammation of larynx can lead to oedema of vocal folds
Causes = infectious (croup) or non-infectious e.g. vocal strain, reflux laryngitis, chronic irritative laryngitis

Often clinically diagnosed – acute present with hoarseness arise over <7 days usually preceding viral URTI and self-limiting
May be airway distress and fever as well
Chronic laryngitis – hoarseness, globus, pain, dysphagia, cough lasting >3 weeks

Question 2

Croup

Answer 2

Classically affects children 6m-6y, peak 2years
Barking/bovine cough, worse at night
Adults may have persistent dry cough, hoarse voice
Preceded by rhinitis, pharyngitis, dysphagia/odynophagia

Question 3

Causative organisms

Answer 3

Nearly always viral – parainfluenza viruses 80%, other URI viruses
Bacterial infection rare – remember bordatella pertussis (whooping cough) and Corynebacterium diphtheriae

Question 4

Pertussis – whooping cough, notifiable

Answer 4

URI characterised by paroxysmal coughing >14-21d duration
Bordatella pertussis/parapertussis
Vaccine preventable but still global health problem with increasing incidence
Immunity is incomplete and not lifelong
UK currently experience resurgence

Question 5

Clinical features

Answer 5

Catarrhal phase – indistinguishable from other URI – highly infectious
Paroxysmal phase – paroxysms of coughing, inspiratory ‘whoop’ may follow, vomiting, seizures, apnoeic episodes
Convalescent phase – resolution but dry cough may persist for months
Usually uncomplicated but children with lung disease or neurological disease increased risk of death

Question 6

Management

Answer 6

Seek expert advice
Admit if severe or high risk
Confirm diagnosis with culture (pernasal swab), serology or PCR
Antibiotics may hasten elimination of bacteria, hence reduce spread but unlikely to shorten disease once paroxysmal phase begins
Macrolides = treatment of choice
Prevention – vaccination
Now offered to women during pregnancy

Question 7

Key diagnostics factors

Answer 7

Presence of risk factors – e.g. recent history URTI, lack Hib or diphtheria vaccine, travel to area with diphtheria/TB endemic, immunocompromise, HIV infection or residence in nursing home
Hoarseness – most characteristic symptom
Dysphagia
Sore throat
Odynophagia
Cough
Hyperaemia oropharynx
History heavy vocal use
Gastro-oesophageal reflux

Question 8

Investigation

Answer 8

Laryngoscopy – performed if patient presents initially to otolaryngology specialist but most GPs aren’t experienced in the technique and diagnose clinically

Other tests to consider:
Biopsy during laryngoscopy if suspect TB – usually general anaesthetic
Oropharyngeal culture – if suspect bacterial infection, diphtheria or TB
Nasal swab for culture – if suspect diphtheria
FBC – if suspect bacterial infection
Rapid antigen test – if suspect group A strep
CXR – if suspect TB
Sputum – if suspect TB

Question 9

Management

Answer 9

Viral laryngitis – voice rest and hydration
Bacterial cause – antibiotics
Vocal strain managed with voice therapy/vocal hygiene