Laryngitis

Symptoms of laryngitis

Laryngitis tends to start suddenly and get worse over the first two to three days. You might notice:

• a hoarse or croaky voice, or losing your voice altogether
• a sore, dry or tickly throat
• an irritating cough that won't go away
• constantly needing to clear your throat
• a feeling of a lump in your throat
• pain when you speak.

Because laryngitis often comes with another illness, such as a cold or flu, you might also have a headache, a runny nose, swollen glands, a mild fever, or pain when swallowing. Your hoarse voice tends to get worse each day you're unwell, and can linger for up to a week after your other symptoms have gone.

Children with laryngitis can also go off their food, run a temperature of 38°C or higher, and, rarely, have breathing difficulties, since their airways are narrower than an adult's.

Causes and risk factors

Most laryngitis is caused by a viral infection, such as a cold, flu or COVID-19, and it's often linked to whatever illness is causing it. Bacterial infections can cause it too, though this is less common, and it's rarer still to catch laryngitis from a fungal infection, which mainly affects people with a weakened immune system or those using inhaled steroids.

Straining your voice, for example by shouting or singing for long periods, can also bring on laryngitis, as can breathing in irritants such as smoke, dust, fumes or chemicals. Other triggers include acid reflux, where stomach acid travels up into your throat, an allergic reaction, or, less commonly, a direct injury to your larynx.

You are more likely to get laryngitis if you smoke or are often around smoke, drink heavily, overuse your voice, or already have a respiratory infection such as sinusitis or bronchitis.

Types of laryngitis

Doctors generally describe laryngitis as either acute or chronic, depending on how long it lasts. Acute laryngitis comes on suddenly, usually because of an infection, and normally settles within a week or two.

Chronic laryngitis lasts longer than three weeks and is less often caused by infection. It's usually linked to an ongoing irritant, such as smoking, heavy drinking, acid reflux, allergies, or continued strain on your voice, so it tends to persist until that underlying trigger is addressed. If there is persistent and unexplained hoarseness in a person 45 years and over, then consider a suspected cancer pathway referral (for an appointment within 2 weeks).

How is laryngitis diagnosed?

Your doctor will usually ask about your symptoms and any recent illnesses, then look inside your throat and listen to your voice. For most short-lived cases, no further tests are needed.

If your doctor wants to look more closely at your vocal cords, they might use a small mirror and light at the back of your throat, or pass a thin, flexible scope through your nose (a laryngoscopy) for a clearer view. They may also take a swab from your throat, arrange a blood test, or ask you to cough up a sample of mucus, particularly if a bacterial infection or another underlying cause is suspected.

If your laryngitis keeps coming back, or your doctor cannot find a clear cause, they may refer you to an ear, nose and throat (ENT) specialist.

How is laryngitis treated?

Looking after yourself at home

Most laryngitis clears up by itself, and looking after your voice is the main thing that helps. Rest your voice as much as you can, and try not to whisper, as this can strain your throat just as much as talking normally.

Drink plenty of fluids, and keep the air around you moist, for example with a bowl of water near a radiator or a humidifier, since central heating and air conditioning dry the air out. Gargling with warm, salty water can also soothe your throat, though this is not suitable for young children.

It is best to avoid smoking, smoky or dusty places, nasal decongestants, and too much caffeine or alcohol, all of which can dry out or irritate your throat further. A pharmacist can suggest paracetamol or ibuprofen, cough syrup, or throat lozenges to ease your symptoms in the meantime.

Medical treatment

If an infection or another specific cause is behind your laryngitis, your doctor may prescribe treatment aimed at that cause. Antibiotics only help if the cause is bacterial, since they don't work against viruses, which cause most cases. Antifungal medicine is used for the rare fungal infections, and corticosteroids may be prescribed to bring down inflammation and swelling.

Other options include medicine to help you cough up mucus more easily, pain relief for discomfort, or, if acid reflux is the cause, medication to reduce your stomach acid. If your voice problems come from long-term overuse, such as with singing or public speaking, speech or voice therapy can help you use your voice in a way that causes less strain.

In rare cases of chronic laryngitis caused by a growth on your vocal cords, surgery may be needed to remove it.

When should I see a doctor?

See your GP if your symptoms have not improved after two weeks, or if you keep getting laryngitis or voice problems. Contact 111, or your doctor urgently, if you have any of the following:

• pain or difficulty swallowing
• swollen glands
• an injury to your neck or throat
• a fever that will not go away
• increasing pain
• blood when you cough.

Call 999 or go to A&E if you or your child are having difficulty breathing, making a high-pitched noise when breathing in, or drooling because swallowing has become too difficult. This is rare, but needs urgent attention, especially in young children, whose airways are narrower.