Introduction

Laryngitis is the inflammation of the larynx (voice box) or vocal cords. This condition can develop when the vocal cords are infected, overused, or irritated. People can develop laryngitis on its own or alongside other conditions such as colds, throat infections, the flu, and tonsillitis. When the vocal cords function normally, they open and close smoothly, allowing sounds to be produced through vibrations. In laryngitis, the vocal cords become swollen, distorting the sound that passes through them, which causes one’s voice to sound hoarse. 

There are two types of laryngitis: acute and chronic. Acute laryngitis is temporary and is usually improved when the underlying cause is treated. Chronic laryngitis usually lasts for more than three weeks.¹

Acute laryngitis is caused by infections with bacteria, viruses, or fungi, or by trauma such as vocal strain. Chronic laryngitis can be caused by inhaled irritants such as allergens and smoke, acid reflux (also called gastroesophageal reflux or GERD), excessive alcohol use, chronic sinusitis, and smoking. Less common causes of chronic laryngitis include bacterial, fungal, and parasitic infections.³ 

For pregnant women with laryngitis, a lot of the regular treatment options are not appropriate.² Laryngitis is not dangerous in pregnancy and will usually pass in 1 or two weeks. However, some treatments for laryngitis can be dangerous to take when pregnant.

Common causes of laryngitis in pregnancy

Laryngitis in pregnant women could be caused by a wide range of causes, such as hormonal changes and infections, amongst others. During pregnancy, the increased levels of oestrogen and progesterone can lead to many changes that affect a woman's voice. These changes could include swollen vocal cords, altered vocal range, increased risk of acid reflux due to changes in position, increased fragility of blood vessels in the vocal cords, reduced lung capacity, and nasal congestion. 

The common causes of laryngitis in pregnancy are explained in more detail below:^4,6

• Swollen vocal cords: caused by fluid retention and metabolic alterations during pregnancy, women might experience swelling in different parts of the body, including the vocal cords, which could lead to an alteration in the voice range 
• Acid reflux: a common problem for pregnant women, as hormonal changes during pregnancy can lead to the relaxation of the lower oesophageal sphincter. Regurgitation is more common when the stomach's capacity is reduced
• Fragile vocal cord blood vessels: dilation of the vocal cords can increase the risk of haemorrhage
• Reduced lung capacity: the chest cavity is pushed up, which could lead to vocal fatigue
• Nasal congestion: swelling of the nasal mucosa reduces airflow through the nose, lowering sound production and quality in the prenasal cavities

The causes of laryngitis are varied. However, laryngopharyngeal reflux (LPR) is an important cause of laryngitis. Research suggests pregnancy-induced changes in the digestive system, including changes in pressure and stomach emptying, are associated with heartburn in pregnant women. Additionally, some studies suggest that pregnant women are susceptible to upper respiratory tract infections as well as laryngitis as a result of the changes in the immune system during pregnancy.⁵ 

Symptoms of laryngitis 

Symptoms of laryngitis can begin abruptly and usually worsen over 2-3 days. The common symptoms of laryngitis include:¹ 

• Hoarseness
• Difficulty speaking
• Sore throat
• Mild fever
• Cough

Less common symptoms include:

• Headache
• Swollen glands
• Runny nose
• Pain when swallowing
• Fatigue and feeling achy⁶

Considerations and risks during pregnancy

Pregnancy is a time when hormonal, metabolic, and organ function changes occur in the body, including the larynx. Changes in function and disease during pregnancy are due to hormonal changes, including the production of oestrogen and progesterone, and to placental hormones such as human chorionic gonadotropin (hCG) and human placental lactogen (hPL). Many cases of laryngitis in pregnant women can be treated conservatively, as symptoms and causes disappear after the baby is delivered. Thus, it is recommended to avoid unnecessary medications and other interventions to reduce potential risks to the baby.⁵

There are many risks to consider during pregnancy, which include changes to the immune system, restrictions on treatment options due to harm to the baby, risk of fatigue, and dehydration. Pregnancy is a unique condition where the immune system is modulated but not suppressed, as pregnant women respond differently to microorganisms.⁷

Non-pharmacological management options

For pregnant women with acute laryngitis, treatments include:⁵

• Voice rest
• Increasing humidity: moisture can be added to the air with a humidifier 
• Steam inhalation with menthol or eucalyptus
• Drinking plenty of fluids 

Thus, these are safe pharmacological options for managing laryngitis in pregnant women without options for any medications. However, if the symptoms are more severe then safe pharmacological options should be considered to avoid any further complications. 

Safe pharmacological management options

For pregnant women with chronic laryngitis, steroids (oral or nebulised) or nebulised adrenaline may be required in order to improve airway function. Furthermore, options such as hospitalisation, oxygen therapy, a humid environment, intravenous antibiotics, and intravenous fluids for hydration may be required for supraglottic infections. Early and efficient airway management is essential to prevent life-threatening complications. Once the laryngeal obstructions resolve, corticosteroids may be required.⁵

For reflux laryngitis, management may include high doses of proton pump inhibitors, such as omeprazole, as both a therapeutic and a diagnostic agent. These proton pump inhibitors are considered safe. However, many patients may fail to recover with PPIs and may require other treatments like Gaviscon liquid. Gaviscon is an antacid that can help with acid reflux by physically coating the stomach and neutralising acid. It is safe to use because it forms a protective barrier and does not enter the bloodstream.⁸

When managing pregnant patients with laryngeal issues, ENT specialists (otolaryngologists), obstetricians, and general practitioners should work together to ensure the health of both the mother and baby.⁵

Summary

The causes and severity of laryngitis determine the most appropriate treatment for pregnant women. There are many considerations and risks during pregnancy, as pregnant women are more susceptible to infections and other complications from laryngitis. Thus, special care and preventive measures would benefit both the baby and the mother.

Safe pharmacological treatments are the most appropriate for acute laryngitis and would help reduce the risk to the baby. However, for cases of chronic laryngitis, it is beneficial to consult otolaryngologists, obstetricians, and general practitioners to protect the health of the mother and fetus and avoid complications.