Laryngitis
Laryngitis means inflammation of the voice box and, in most cases, swelling of the vocal cords.
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Medicines commonly prescribed for Laryngitis
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: TABLET, 650 mgActive substance: paracetamolManufacturer: Laboratorios Combix S.L.U.Prescription requiredDosage form: TABLET, 1000 mgActive substance: paracetamolManufacturer: Aurovitas Spain, S.A.U.Prescription requiredDosage form: TABLET, 500 mgActive substance: paracetamolManufacturer: Mabo Farma S.A.Prescription not required
Laryngitis means inflammation of the voice box and, in most cases, swelling of the vocal cords. The voice drops, turns husky and low, sometimes disappears altogether, the throat tickles and you find yourself clearing it over and over. Acute laryngitis is almost always viral and settles by itself within a week or two. Two things are worth understanding: how to help the voice come back sooner, and when hoarseness is not a cold at all.
What happens to the vocal cords
Sound is made when two thin folds in the voice box come together and start to vibrate in the stream of air leaving the lungs. Those vibrations are fast and remarkably precise, and the smallest thing upsets them. When the folds become inflamed they swell, grow heavier and lose their suppleness: they no longer close fully, some air escapes without making any sound, and the vibration turns uneven. Hence the characteristic tone — low, husky, breathy — and the sense of having to push the voice out.
Understanding the mechanism explains the guiding principle of treatment. Swollen tissue heals at rest, and anything that makes the folds strike each other harder puts that healing off. This is why the mainstay in laryngitis is not gargles or syrups but voice rest and moisture.
How it shows itself
Laryngitis usually starts abruptly, gets worse over the first two or three days and then eases. The typical picture is this:
- a husky, cracked voice that sounds worse by the end of the day;
- complete loss of voice for a day or two — alarming, but not in itself dangerous;
- a dry tickly cough that brings no relief;
- a constant urge to clear the throat;
- dryness, scratchiness and mild soreness, especially first thing in the morning;
- discomfort or effort when speaking and when trying to reach a higher note.
Laryngitis rarely comes alone: more often it is part of an ordinary cold or of flu, so a blocked nose, a temperature and aching go with it. If the voice stays clear and only the throat hurts, this is more likely pharyngitis or tonsillitis — neighbouring conditions, but different ones that behave in their own way.
Laryngitis in a child, and croup
In small children the airway at the voice box is narrow, and the very swelling that merely spoils an adult's voice narrows a child's breathing passage. That is croup, commonest between about six months and three years and almost always at night. It is easy to recognise: a barking, seal-like cough, a hoarse voice and noisy, whistling breathing in.
The first thing to do is to calm the child and calm yourself: crying and fright narrow the airway further. Hold the child upright in your arms and offer cool, moist air, by a slightly open window or in a steamy bathroom. The mainstay of croup treatment is a corticosteroid prescribed by a doctor; a single dose usually cuts the attack short, and that decision belongs to a medical professional, not to the family.
Call an ambulance (in Spain, Italy, Portugal, Poland and Ukraine on the single European number 112) if a child or an adult develops any of the following:
- noisy, whistling breathing in at rest, not only when crying or moving about;
- skin sucking in between the ribs, above the collarbones and below the breastbone with each breath, nostrils flaring;
- bluish or very pale lips, drowsiness, confusion;
- the child sits leaning forward with the mouth open, drooling, unable to swallow;
- severe throat pain with a high temperature and a muffled voice while the throat itself looks almost clear.
The last two points describe epiglottitis, inflammation of the epiglottis. It is rare but genuinely dangerous, and the airway can close within hours. If it is suspected, do not look into the throat with a spoon and do not lay the person on their back: either can trigger a spasm. Keep the child in whatever position they choose and wait for the ambulance.
What helps at home
An adult with ordinary laryngitis does not usually need to see a doctor. What does help is this.
- Talk less — and never whisper. Whispering strains the folds as much as ordinary speech and sometimes more. Speak quietly but in a normal voice, and take breaks.
- Drink through the day: water, warm drinks, anything mild. A dried-out lining repairs itself more slowly.
- Add moisture to the air; central heating and air conditioning dry it out more than people realise. A humidifier helps, and so does simply breathing over steam.
- Give up smoking for these days, keep away from other people's smoke, and avoid dusty or smoky rooms.
- Go easy on strong coffee and alcohol, which dry the lining out.
- For a sore throat, the usual pharmacy painkillers: paracetamol and, if nothing rules it out, a non-steroidal anti-inflammatory. Lozenges and gargling with warm salty water soothe the throat; they do not reach the cords themselves, but they make the scratchiness easier to live with. Gargling is not suitable for young children.
- Break the throat-clearing habit. Every "ahem" slams one fold against the other. Take a sip of water or swallow calmly instead.
What is best avoided: decongestants and "cold and flu" sachets for more than a couple of days, since they dry the lining and do the voice no favours; pressing for an antibiotic, because acute laryngitis is almost always viral and an antibiotic will not shorten it by a single day; and inhaling whatever comes to hand or applying heat to the neck while running a high temperature.
When to see a doctor, and what should raise concern
It is worth seeing a doctor if the voice has not begun to recover after two weeks, if laryngitis returns several times a year, or if you wake up hoarse every morning.
There is a separate set of signs that calls for the larynx to be examined with an endoscope rather than another course of gargles:
- hoarseness lasting more than three weeks, particularly in a smoker over forty;
- a firm lump appearing in the neck;
- difficulty or pain on swallowing, a sense that food catches on something;
- pain in one ear while that ear is healthy;
- blood in the phlegm;
- weight loss with no explanation.
Behind that combination there may be a tumour of the larynx, and its early forms respond well to treatment — but only while they are found early. The endoscopic examination takes a couple of minutes and is done under local anaesthetic.
At the appointment the doctor will look at the throat, ask about how the voice is used, about reflux and about your work, take a swab or arrange blood tests if needed, and, where episodes keep repeating, refer you to an ear, nose and throat specialist or a voice clinic.
Why it keeps coming back
When hoarseness returns again and again, the reason is usually not infection but a cause that never went away. The commonest are these:
- Heavy use of the voice. Teachers, nursery staff, shop assistants, call-centre workers, coaches, singers — whole days spent at raised volume, often in a noisy room. What helps here is not silence after each crisis but voice training and a workable routine: breaks, a microphone, water within reach.
- Acid coming up from the stomach. Recognisable by morning hoarseness, habitual throat-clearing, a lump-in-the-throat feeling and the absence of heartburn: the acid reaches the larynx without producing the classic burning behind the breastbone. Not eating just before bed, raising the head of the bed and treatment prescribed by a doctor all help.
- Smoking. Years of tobacco produce lasting swelling of the folds, which in women makes the voice noticeably deeper and rougher. It recovers in part after stopping.
- Dry air and allergy — the heating season, air conditioning, dust, animal hair, pollen.
- Inhaled steroids for asthma. Hoarseness is a well-known side effect. A spacer and rinsing the mouth after each dose usually settle it; the inhaler itself is not stopped without advice.
- Less often: an underactive thyroid, nodules and polyps on the vocal cords, the after-effects of neck surgery.
The flu vaccination deserves a separate mention: it does not treat laryngitis, but it removes one of the commonest reasons for getting it.
Online consultation
At an online appointment the doctor, going by how the voice sounds, the other symptoms and how long they have lasted, helps tell ordinary viral laryngitis from something that needs the larynx examined, and advises what to do right now so that the voice returns sooner. Parents of a child with a barking cough are talked through how to manage the night, which signs allow watching at home and which mean calling an ambulance. Where episodes keep repeating, the doctor works out the likely cause — voice load, reflux, an inhaler, dry air — suggests what to change, and says when a voice specialist is needed and what to bring to that appointment.
This material is for information only and does not replace medical advice.
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