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How is laryngitis diagnosed?
Viewing the Voice Box Is Important
Laryngitis
is diagnosed by examination of the larynx. The laryngeal examination
may include a mirror examination or specialized magnified viewing of
the voice box (rigid laryngoscopy or laryngeal stroboscopy). (For more information, see Laryngoscopy / Stroboscopy.)
The following are investigated during laryngoscopy:
- Area with inflammation
- Clues to possible cause(s) of laryngitis
- Other voice box lesions or problems already present in addition to laryngitis
Assessing Vocal Fold Vibration With Stroboscopy
- Stroboscopy
is a procedure that enables an assessment of the vibratory function of
the vocal folds. Alterations in vocal fold vibration may result from
the swelling or from vocal fold lesions that may be present. (For more information, see Laryngoscopy / Stroboscopy.)
- Often,
laryngitis can make symptoms quite noticeable; for instance, a patient
with laryngitis may be prompted to seek medical care for a vocal fold
lesion that was already present (but not noticed).
Typical Appearance of Voice Box
On
laryngeal examination, laryngitis appears as redness and/or swelling of
the larynx. This swelling may occur throughout the larynx (diffuse) or
may occur only on the vocal folds or in the back of the larynx. Typical
patterns of laryngitis are:
- Diffuse (widespread) swelling: Usually the result of an inhaled cause of laryngitis, such as smoke or an air pollutant.
- Swelling limited to vocal folds: Usually occurs due to mechanical causes of laryngitis, such as vocal misuse or overuse.
- Swelling in the back of the voice box (larynx): Also known as posterior laryngitis, occurs most commonly with backflow of stomach fluids to the throat and voice box area (laryngopharyngeal reflux (LPR)).
Investigating Possible Cause(s) of Laryngitis
General guidelines:
- More than one factor may cause laryngitis.
- Laryngitis
is a general term describing an area of inflammation; the cause of the
laryngitis needs to be identified before a complete medical diagnosis
can be offered.
- The identification of the cause of
laryngitis and other associated problems is required to determine
optimal therapy and to maximize healing results.
Role of Allergies in Voice Disorders
- The exact role of allergies in patients with voice disorders is highly controversial.
- Some
otolaryngologists with a very strong orientation to and interest in
allergic disease believe that the majority of voice problems are caused
by either environmental or food allergies.
- However,
environmental allergies are extremely common, such that any patient
with a voice problem may also have mild to moderate environmental
allergies.
- A direct connection of a voice problem to a
coexisting allergy problem has not been strongly and convincingly made
in a majority of patients with voice problems. Patients with voice
problems should be examined carefully with high-quality laryngeal
examination, review of the patient's symptoms, and allergy evaluation
if indicated.
Role of Laryngopharyngeal Reflux in Laryngitis
- The role of laryngopharyngeal reflux disease (LPR) in laryngitis specifically and in voice disorders in general is highly controversial.
- Many
otolaryngologists and laryngologists believe that a high degree of a
patient's primary voice disorder comes from unsuspected and subtle
laryngitis due to gastric acid reflux. However, other otolaryngologists
and laryngologists believe that LPR is not as prevalent in the field of
voice disorders.
- One reason for this controversy is the difficulty in making a definitive diagnosis of LPR. (For more information, see Reflux Laryngitis.)
 Red Flag
"Chronic Laryngitis" Is a Vague Term – specific cause needs to be identified to arrive at diagnosis and determine appropriate treatment
Chronic
laryngitis, without identification of a cause, is not a specific
diagnosis. A patient diagnosed with chronic laryngitis should ask the
otolaryngologist to identify the underlying cause of the chronic
laryngitis.
Most otolaryngologists avoid the term "chronic
laryngitis" since it has no specific meaning and thus does not provide
helpful information to the patient or other physicians.
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