Laryngitis
Laryngitis, an inflammation of the larynx, often occurs as a result of voice abuse
or exposure to dust, chemicals, smoke and other pollutants or as a part of a URI. It also
may be caused by isolated infection involving only the vocal chords. Laryngitis is also
associated with gastroesophageal reflux.
Laryngitis is very often caused by the pathogens that cause the common cold
and pharyngitis; the most common cause is a virus, and laryngitis is often associated
with allergic rhinitis or pharyngitis. Bacterial invasion may be secondary. The onset of
infection may be associated with exposure to sudden temperature changes, dietary
deficiencies, malnutrition, or an immunosuppressed state. Viral laryngitis is common in
the winter and is easily transmitted to others.
Risk Factors
Allergies - people with allergies can often experience a sore throat due to their
condition and this can easily develop into laryngitis
Excessive alcohol intake - excessive alcohol intake can is a risk factor for not
only GERD (gastro-eosophageal reflux disease) which can result in laryngitis, but
the excessive alcohol intake itself can irritate the larynx even if GERD does not
occur and increase risk of laryngitis
GERD - people with gastro-eosophageal reflux disease (GERD) have an
increased risk of developing laryngitis due to the acidic contents of the stomach
regurgitating up the eosophagus and irritating the whole of the throat (and often
the lungs too) and increasing risk of laryngitis
Lower respiratory infection - people with any type of lower respiratory infection
such as bronchitis, croup, pleurisy, pneumonia and tuberculosis have an
increased risk of developing laryngitis due to the infection of the lungs and
increased coughing possibly also causing infection and irritation to the larynx too.
Polyps on the vocal chords - nodular growths on the vocal chords are a
common risk factor for the development of laryngitis, as the vocal chords sit on
top of the larynx and if the vocal chords are inflamed due to the polyps, the larynx
can also become inflamed and hoarse resulting in laryngitis
Smoking - smoking cigarettes is a very common risk factor for the development
of any type of upper and lower respiratory condition, including laryngitis. Smoking
cigarettes irritates and damages the larynx tissue, resulting in laryngitis. Not only
this, but smoking dampens the immune system, resulting in increased risk of
respiratory infection of any type, not just laryngitis
Upper respiratory infection - any type of upper respiratory infection, such as
colds, influenza, pharyngitis, sore throat (with or without productive cough)
increase the risk of developing laryngitis due to the infection of the upper
respiratory tissues. Laryngitis can result as a secondary infection due to the initial
infection in the upper respiratory tissue
Pathophysiology
Acute laryngitis is commonly due to infection but there are rarer causes. The
basic pathophysiology is inflammation of the mucosa lining the vocal folds and larynx. If
infection is involved, white cells aggregate to remove infectious material from the area.
Edema of the laryngeal lining increases the amount of pressure required to produce
sound, resulting in dysphonia or aphonia. Changes to the structure of the larynx may
also result in a lower register of speech.
Chronic laryngitis can be due to a variety of different causes, including reflux,
allergy, trauma and autoimmune disease. Depending on the cause, there may be
laryngeal spasm, hyperemia, edema, inflammation and various changes to the
morphology of the laryngeal mucosal cells.
Manifestations
Acute Laryngitis
Hoarseness or aphonia (complete loss of voice)
Cough
Throat feels worse in the morning and improves in a warm climate
Dry cough and a dry sore throat that worsens in the evening
Chronic Laryngitis
Persistent hoarseness
Diagnostic Procedure
Laryngoscopy. The doctor can visually examine the vocal cords in a procedure
called laryngoscopy, by using a light and a tiny mirror to look into the back of the
throat. Or the doctor may use fiber-optic laryngoscopy. This involves inserting a
thin, flexible tube (endoscope) with a tiny camera and light through the nose or
mouth and into the back of the throat. Then the doctor can watch the motion of
the vocal cords as the patient speak.
Biopsy. If the doctor suspects laryngeal cancer taking a sample of tissue for
examination under a microscope is ordered.
Medical Management
Acute laryngitis
Resting the voice
Avoiding irritants
Inhaling cool steam or aerosol
Antibacterial therapy ~ if the laryngitis is part of more extensive respiratory
infection caused by a bacterial organism
Chronic laryngitis
Resting the voice
Eliminate any primary respiratory tract infection
Eliminating smoking
Avoiding second hand smoking
Pharmacologic Treatment
Corticosteroid (beclomethasone) ~ used to reduce inflammation.
Antibiotics ~ if there is a presence of infection
Nursing Management
Instruct the patient to rest the voice and to maintain a well-humidified
environment.
If laryngeal secretions are present during acute episodes, expectorant agents are
suggested, along with a daily fluid intake of 2 to 3 L to thin secretions.
Instruct the patient about the importance of taking prescribed medications.
In cases involving infection, the nurse informs the patient that the symptoms of
laryngitis often extend to 10 days after completion of antibiotic therapy.
Nursing Care Plan
1. Ineffective airway clearance related to thick secretions
Intervention
1. Position head appropriate for age
and condition
2. Elevate
head
of
the
bed,
encourage early ambulation, or
change clients position every 2
hours
3. Encourage deep breathing and
coughing exercises or splint
chest/incision
4. Increase oral fluid intake at least
2,000 mL/day within cardiac
tolerance.
5. Administer
medications
as
indicated
Rationale
To open or maintain open airway in an at
rest or compromised individual.
To take advantage of the gravity
decreasing pressure on the diaphragm
and enhancing drainage of/ ventilation to
different lung segment.
To maximize effort
Hydration can help prevent accumulation
of viscous secretions and improve
secretion clearance.
To relax smooth respiratory musculature,
reduce airway edema and mobilize
secretions
6. Position appropriately (head of the To prevent vomiting with aspiration into
bed elevated, side lying) and lungs
discourage use of oil based
products around nose
2. Acute pain related to upper airway irritation secondary to infection
Intervention
Rationale
1. Obtain
clients/
SOs In order to fully understand clients
assessment of pain to include pain symptoms.
location, characteristics, onset,
duration, frequency, quality,
intensity. Identify precipitating
or aggravating and relieving
2.
3.
4.
5.
6.
factors.
Promote
comfort
measure
(touch, repositioning, use of
heat or cold packs, nurses
presence), quiet environment
and calm activities
Encourage verbalization of
feelings about the pain such as
concern about tolerating pain,
anxiety pessimistic thoughts.
Observe nonverbal cues and
pain behaviors and other
objective
defining
characteristics
as
noted
especially in persons who
cannot communicate verbally.
Administer
analgesics
as
prescribed
Encourage
adequate
rest
periods.
To promote nonpharmacological pain
management
To evaluate coping abilities and to
identify areas of additional concern.
Observations may not be congruent
with verbal reports or may be only
indicator present when client is unable
to verbalize.
To maintain acceptable level of pain.
To prevent fatigue that can impair
ability to manage or cope with pain.
