What is laryngitis?

Laryngitis is caused usually due to your larynx (voice box) becoming swollen or irritated as a result of vocal strain, a viral infection or irritation. Many of these factors are linked to lifestyle choices like heavy smoking or alcohol overconsumption. Common symptoms or indicators include: ‘raspyness’ or hoarseness in voice, a dry cough or vocal fatigue due to vocal strain.¹

People with a history of smoking or heavy drinking are more vulnerable to developing chronic laryngitis. The irritation and damage to the vocal cord caused by tobacco smoke or alcohol results in persistent inflammation and chronic irritation. In turn, this increases the risk for complications with vocal cord nodules, polyps and even cancer. The recovery among such patients is slow and the condition more likely to reoccur due to extended and continuous exposure to irritants in smoke and alcohol.²

How does smoking affect your larynx?

Smoking leads to irritation and inflammation in the tissue surrounding the larynx called the laryngeal tissues. Prolonged exposure to tobacco smoke can cause changes in the shape of the vocal fold epithelium, leading to disruption in the function of your vocal cords. This is the source of symptoms such as dry cough, vocal fatigue and hoarseness, and can further lead to conditions like chromic laryngitis and other complications.³ Reports suggest that the intensity of the smoke inhaled is directly proportional to the risk of cancer incidence, as the smoke causes mutations in the laryngeal cell followed by cancerous growth in larynx tract.⁴ Thus, history of smoking not only reduces recovery rate but also increases chances of recurrence.⁵

How does alcohol consumption affect your larynx?

Alcohol is a diuretic, meaning that leads to dehydration of your vocal cords and mucosal membranes. Therefore, alcohol abuse can lead to persistent irritation and discomfort.⁶ Alcohol can also worsen an existing condition called gastroesophageal reflux disease (GERD) where stomach acid flows back into the oesophagus.⁷ This can further irritate the larynx, leading to chronic inflammation. 

Laryngitis can be further defined as acute laryngitis and chronic laryngitis.

What is acute laryngitis?

Acute laryngitis is often a mild form of laryngitis and typically lasts between three to seven days. Causative agents include infectious or non-infectious forms. The infectious form of acute laryngitis is most common in adults, caused due to viral agents like rhinovirus and coronavirus. This presents itself as a barking cough, which may further progress into upper airway infection resulting in an obstruction in our respiratory pathway called the inspiratory stridor. 

Whereas the non-infectious form is due to overuse or trauma of your vocal box, allergies, asthma, smoking, environmental pollution or underlying disease conditions such as gastroesophageal reflux. This can be resolved in a period of 15 days. However, if the symptoms persist for longer than 15 days, this is an indicator of the condition’s transition to chronic phase.  Acute laryngitis is most common in adult population but can affect patients of any age from as young as three to upwards of 40 years old.¹

What is chronic laryngitis?

Laryngitis is in the chronic phase when the duration exceeds 14 days, usually caused by chronic inflammation of the larynxt. The most common cause of this condition is laryngopharyngeal reflux. However, other causes include poor laryngeal hygiene caused due to lifestyle choices like smoking, excess alcohol or caffeine intake. It may also include some bacterial and fungal infections for example, blastomycosis and tuberculosis. Signs and symptoms like chronic or recurrent sore throats, hoarseness of voice, odynophagia, and prolonged episodes of coughing are usually associated with consequences of chronic laryngitis in patients.²

Strategies to manage laryngitis?

The treatment of laryngitis is a multistep process, depending on the phase of the inflammation:

• Vocal Rest: This includes reducing speaking, and whispering - which may strain the cords more than regular speech does. You can only allow the inflamed larynx time to heal by keeping your vocal use to a minimum³
• Hydration: Drinking plenty of water can help keep the throat moist, soothing irritation and promote healing in the larynx. Furthermore, patients can use humidifiers to keep the airways moist, especially in dry environments and winter when indoor heating is common and dries out the atmosphere³
• Lifestyle modifications: Quitting smoking and/or drinking is essential to manage the symptoms to reduce the damage to the laryngeal tissues over time. This helps to improve throat health and reduces long-term complications upon your vocal and respiratory health. One way to make this lifestyle modification can be through undertaking behavioural therapy or nicotine replacement therapies like using chewing gums and lozenges to reduce the withdrawal symptom, thus making the quitting process easier. Additionally, joining support and counselling group can help patients with their journey on reducing/abstinence from drinking and/or smoking³
• Dietary modification: This is recommended for patients with GERD. Avoid caffeinated drinks, fatty food, spicy food chocolate, and peppermint. Also, avoiding late meals so you should have your meals at least three hours before going to bed¹
• Antibiotics: For chronic laryngitis, anti-inflammatory medications like corticosteroids may be prescribed by your doctor. Taking such medications will help decrease inflammation of the vocal cord, significantly. If laryngitis is worsened by GERD, specialist may recommend medication like proton pump inhibitors (H2 blockers) to mitigate the acid reflux thus protecting larynx from further irritation³
• Plan a visit to the specialist: In the case of persistent and/or deteriorating symptoms, visiting an Otolaryngologist is recommended. They will perform a detailed examination of the larynx and offer the most appropriate treatment. In some cases where suspicious lesion or masses are detected, a biopsy may be performed³

Summary

Laryngitis is the infection or inflammation of the larynx. It is commonly found among individuals who have a history of smoking or heavy drinking. These lifestyle choices worsen the condition, as smoke irritates the laryngeal tissues whilst alcohol dehydrates the vocal cords. There are two phases in this condition: Acute laryngitis - resolved within 3-7 days, and chronic laryngitis - which persists more than 14 days. Laryngitis can be managed by voice rest, hydration, reducing or avoiding smoking, avoiding heavy alcohol intake, dietary changes especially in cases with GERD and treatment with antibiotics depending on your symptoms. Visiting your nearest Otolaryngologist is recommended if symptoms persist. Laryngitis requires a wide array of management strategies, including lifestyle modification andmedical intervention. In some cases, professional counselling is necessary for patients with a history of smoking and drinking because there is a need to address both the symptoms and the disease process itself.

FAQs

Can you drink alcohol when you have laryngitis?

No, it is advised not to drink alcohol when you have laryngitis. This is because alcohol dehydrates your vocal cord, leading to increased irritation and larynx inflammation. Thus, drinking alcohol will further worsen your condition.

Should I stay away from people if I have laryngitis?

Laryngitis is not a contagious condition, so you don’t need to stay away from people. However, vocal rest is advised to manage the symptoms.⁸

How do you treat chronic laryngitis?

Antibiotics and visting a Otolaryngologist is the best way to treat chronic laryngitis.

Can I go to work with laryngitis?

You can go to work with laryngitis. However, it is advisable to avoid whispering and speaking to reduce the strain on your vocal cords.  

How many days should you rest your voice with laryngitis?

You can practice voice rest for anywhere between 48 hours and a week, to manage your symptoms.  

What is the longest laryngitis can last?

Laryngitis in the chronic state can last for up to three to four weeks. 

What foods should you avoid with laryngitis?

Avoid eating spicy food, fatty food and anything with high acid content like coffee and tomato juice.  

What happens if laryngitis goes untreated?

Laryngitis will transform into chronic state and can further lead to permanent damage to vocal cords if left untreated.