Laryngitis- a condition that leads to inflammation of the larynx, also called the voice box. The larynx is located in the throat above the windpipe, consisting of the epiglottis, hyoid bone, thyroid cartilage and laryngeal muscle. Acute laryngitis lasts for 2 weeks, and chronic laryngitis lasts more than 2 weeks.

Chronic laryngitis -Persistent voice changes are usually unnoticed, as it is painless, unlike acute laryngitis.

Throat overuse, injury, misuse, trauma due to various directly or indirectly responsible factors, such as professional work where voice is the main attribute, teacher or speaker, working in factories where inhaling of dust and smoke, singing and dancing teachers, and environmental factors such as pollution, can be asymptomatic and lead to chronic laryngitis.

 Autoimmune disease and pre-existing disease can also contribute to the severity ranging in chronic laryngitis.

Autoimmune disease -Research and case reports have concluded that autoimmune disease tends to cause chronic laryngitis, and the symptoms worsen. Immunity plays an important role in living metabolic activity; weakening of the immune system brings forth severity in chronic conditions such as Laryngitis, pharyngitis, sinusitis, etc.

Autoimmune disease disturbs the regular routine of a person, causing stress while speaking, sleep disturbance, weakness, dryness in the throat, joints and musculoskeletal pain, nervous system disorder.

Genesis

The insistence on particular responsible factors or conditions responsible for autoimmune disease is unspecified, though 90% gut system is responsible for the autoimmune system as the microbes are settled in the gut and lead to weakening of the rest connected systems of the organism. Yet it may be a hypothesis interpreted by few researchers.

 Chronic laryngitis is closely associated with autoimmune disease. Some systemic features of chronic conditions like rheumatoid arthritis, laryngeal manifestations, GERD, sarcoidosis, and past allergic conditions are autoimmune in it.

Symptoms

• A lump in the neck is clearly visible
• Hoarseness lasting more than 2 weeks
• Difficulty in swallowing food
• Weight loss
• Weaknesses more often
• Breathing issues
• Joint and muscle pain
• Coughing

What are the various conditions of autoimmune disease responsible for voice hoarseness?

Clinically presented case reports list a few conditions reported to date of autoimmune linked with chronic auto laryngitis.

The airway system is widely affected by autoimmune conditions such as:

• Rheumatoid arthritis is, inflammation of joints due to the immune system attacking its own tissue. This condition affects the vocal cords, causing inflammation of the cricoarytenoid joint (or CA joint), leading to a painful throat, struggle to breathe normally, and poor voice quality. ‘Bamboo nodes’ is a poorly developed rheumatic system that shows bilateral nodes present in the vocal cords that lead to inflammation and swelling in the rheumatic system, causing laryngeal malfunctions. Most females are affected in this case
• Myasthenia gravis (MG), a chronic autoimmune disorder leading to weakening of skeletal muscles due to dysfunction of communication between nerves and muscles. Painful breathing and swallowing are the conditions caused by MG. It is irreversible, hence early diagnosis can help in functional and better survival
• Sjögren syndrome, dryness of the eyes and mouth, causing inflammation due to irritants from the airway. The immune system attacks the glands that make moisture, leading to this syndrome. It can be considered a genetic disorder as gene alteration leads to physiological changes in the glandular region to unproduced the moisture
• Lupus, a chronic condition that lasts long due to an attack of the immune system on healthy cells and tissue mistakenly, is also mainly a genetic disorder that leads to inflammation of various body organs, such as the throat, mouth, lungs, brain, heart, and joints
• Sclerosis, the immune system mistakenly attacks neuron cells of the brain and spinal cord, a rare genetic disorder, also causes chronic autoimmunity due to swelling in various organs of the body system

Immunity and voice disorders

The defect in the immune system tends to malfunction the defence mechanism to fight any foreign particle entry through the airway or cause inflammation and swelling of the thoracic cavity, usher in the auto laryngitis condition, and damage the vocal cords.

Laryngeal manifestations such as dysphonia, inflammation and dysfunction of the vocal cord mainly result from misuse of the voice box, affecting voice quality, causing dyspnoea due to underlying impeded vocal folds.

Anatomy & pathophysiology

Immune-linked larynx anatomy consists mainly of 3 parts: supraglottis, glottis and subglottis. Laryngeal lymphoid tissue located in the supraglottis is associated with various immune disorders.

• Relapsing polychondritis is an inflammation of cartilaginous and proteoglycan tissue. The organs affected are the eyes, nose, ears and heart, connective tissue deformation leading to fatal injury through the airway system
• Sarcoidosis malformation or trauma to the supraglottic structure, causing swelling of the larynx
• Amyloidosis is the abnormal formation and deposition of amyloid protein fibres. It is a rare condition, as genes and physiological alterations affect the head and neck region, swelling and tenderness of the upper body region
• Wegener's granulomatosis, also known as GPA, Granulomatosis with polyangiitis, inflammation of blood vessels, damages major organs of the body

Investigation

• Laryngoscopy, a small device with a camera, is inserted through the mouth, and the examination of the larynx condition is observed
• CT SCAN can help better understand swelling and the presence of nodules of the vocal cords
• Autoimmune markers via serology.
• Blood test and TSH level test at primary diagnosis.
• Specialised experts, for a throat otolaryngologist and for rheumatoid issues rheumatologist must be consulted if the severity persists

Treatment and management

• Voice therapy- management of voice and speech with the help of a therapist specialised in vocal and throat care, who will advise a few exercises to overcome pain
• A short course of Corticosteroids is prescribed for autoimmune laryngitis. They reduce inflammation in the larynx, relieving symptoms like hoarseness and pain
• Immunosuppressive medicines help to control the autoimmune response, making the immune system less active
• Medications like methotrexate or azathioprine are frequently used as per the required doses. Patients are monitored closely due to risks associated with reduced immune function.
• Lifestyle changes are required when a chronic condition leads to severe difficulty
• Nutrition and food intake play an important role in controlling the pain, causing nausea and swelling or burning sensations.
• Genetic testing and counselling must be done to prevent future generations from developing the disorder and to learn more about prevention
• Nurturing your voice takes possible care, as it is the only way to communicate your feelings, thinking, if the hoarseness and pain continue for more than a week, consult an expert immediately

Frequently asked questions

What is the common cause of laryngitis?

Environmental factors are held responsible, directly, indirectly for causing laryngitis. eg, viral, bacteria, dust, smoke, etc...

Can an autoimmune disorder be cured at home or with the help of a general physician?

Although a general physician can help with localised treatment but if the conditions last for long, an expert opinion is a must to avoid worsening of the chronic condition.

Is laryngitis associated with autoimmune or is there any other disorder too?

Autoimmune disorder is a rare condition, especially since few suffer from pre-illness in regular updates, people have cold and flu, hence laryngitis can have other factors too responsible.

How can I recover my voice from anything other than medicine available?

Yes, if the conditions are acute, voice therapy sessions are available; they provide various exercises and a diet to recover from voice hoarseness.

Can a prenatal test confirm a genetic alteration that causes autoimmune disease linked to laryngitis?

The ongoing research on genetic testing is trying to get better information, but the specific gene responsible is still a challenge.