Laryngitis and other laryngeal inflammation: acute, chronic, TB, perichondritis and congenital webs
- Topic
Most laryngitis is a viral cold of the voice box that settles in days; hoarseness lasting weeks needs the larynx to be seen.
See it in 3D: Vocal folds · Epiglottis · Arytenoid cartilages · Thyroid cartilage · Cricoid cartilage
What it is
Laryngitis is inflammation of the larynx. Acute laryngitis lasts less than 3 weeks and is usually viral, part of a cold, or caused by shouting; the voice comes back with rest. When inflammation lasts longer it is chronic laryngitis, and the cause is usually an irritant that keeps acting: tobacco, reflux, voice overuse, inhaled corticosteroids, dry air or pollutants. Some chronic laryngitis is specific: tuberculosis, fungal infection, or chondritis after radiotherapy or trauma. In children the same inflammation in the narrow subglottis or supraglottis causes croup or epiglottitis, which threaten the airway. Chronic laryngitis can look like cancer, and smokers have both, so the rule is simple: hoarseness that does not settle is examined with laryngoscopy. Congenital webs are a different, structural cause of a weak cry and stridor.
Structure
- Acute infectious laryngitis: viral (rhinovirus, influenza, parainfluenza, adenovirus); bacterial or fungal mainly in smokers and immunosuppressed patients.
- Acute non-infectious: voice trauma (shouting, singing), inhaled irritants or smoke, allergy.
- Children: croup (subglottic, parainfluenza virus, barking cough), epiglottitis (supraglottic, Haemophilus influenzae type b where unvaccinated, streptococci), diphtheria (grey adherent membrane).
- Chronic non-specific: smoker's laryngitis, Reinke oedema (polypoid swelling of both folds in heavy smokers), reflux laryngitis, chronic hyperplastic laryngitis with leukoplakia.
- Chronic specific: tuberculosis, fungal (candida, histoplasmosis, paracoccidioidomycosis), leprosy, syphilis, sarcoidosis, granulomatosis with polyangiitis.
- Perichondritis and chondritis: after radiotherapy, trauma, prolonged intubation or high tracheostomy; relapsing polychondritis is autoimmune.
- Congenital web: incomplete recanalisation of the larynx, mostly a membrane joining the front of the vocal folds.
Laryngeal inflammation: who, what you see and the next step
| Condition | Typical patient | Laryngoscopy | Next step |
|---|---|---|---|
| Acute viral laryngitis | Any age, with a cold | Red, swollen vocal folds | Voice rest, fluids, humidified air; no antibiotics |
| Reflux laryngitis | Throat clearing, globus, chronic cough | Posterior laryngeal swelling and redness | Diet and lifestyle changes; proton pump inhibitor trial |
| Smoker's laryngitis and Reinke oedema | Heavy smoker | Thick folds, polypoid swelling | Stop smoking; ENT follow-up; surgery for selected cases |
| Leukoplakia (chronic hyperplastic) | Smoker or drinker | White patch on the fold | Biopsy to rule out dysplasia or cancer |
| Laryngeal tuberculosis | Active lung TB, HIV, contacts | Ulcers, swelling, granulations | Biopsy, sputum tests, chest X-ray; TB treatment and isolation |
| Candida laryngitis | Inhaled corticosteroids, immunosuppression | White plaques | Antifungal; rinse after inhaler use |
| Perichondritis | After radiotherapy, trauma or intubation | Swelling with tender cartilage | Same-day ENT; antibiotics; rule out recurrence |
| Congenital web | Newborn or infant | Membrane across the front of the glottis | ENT and genetics (22q11.2), cardiac assessment |
In clinical practice
- Acute laryngitis: hoarse or lost voice, dry cough, sore throat, mild fever; the folds are red and swollen.
- Reflux laryngitis: throat clearing, globus, chronic cough and hoarseness, often without heartburn; swelling of the posterior larynx.
- Reinke oedema: low-pitched, rough voice in a heavy smoker (often a woman); both folds look like water bags.
- Leukoplakia of the vocal fold is a white patch that may hide dysplasia or cancer: it is biopsied, not treated blindly.
- Laryngeal TB: hoarseness, pain on swallowing, referred ear pain and cough, usually with active lung TB; ulcers or swelling of the folds and the posterior larynx.
- Perichondritis: severe pain, tenderness of the laryngeal cartilages, swelling and sometimes airway narrowing; after radiotherapy it may mean radionecrosis or tumour recurrence.
- Laryngeal candidiasis: white plaques on the larynx in users of inhaled corticosteroids or in immunosuppressed patients.
Next step / Initial management
- Acute laryngitis without red flags: voice rest (no whispering), fluids, humidified air, stop tobacco; no antibiotics; review if not better in 3 weeks.
- Hoarseness lasting more than 3 to 4 weeks: refer to ENT for laryngoscopy; the referral is a priority (within two weeks) in smokers, drinkers and when there is a neck lump, haemoptysis, dysphagia or pain on swallowing.
- Suspected reflux laryngitis: diet and lifestyle measures and a proton pump inhibitor trial, without delaying laryngoscopy when hoarseness persists.
- Suspected laryngeal TB: chest X-ray, sputum smear and molecular test, airborne isolation, HIV test, laryngeal biopsy by ENT; notify and start standard TB treatment through the TB programme.
- Inhaled corticosteroid users with hoarseness: check inhaler technique and mouth rinsing; antifungal if candida is confirmed.
- Stridor, drooling, inability to swallow saliva or a child sitting forward: refer the same day as an emergency; keep the patient calm and upright and do not examine the throat with a tongue depressor.
Test yourself
Think of the answer, then tap the question to see it.
A 30-year-old teacher lost her voice two days after a cold. She has no stridor. What is the management?
Acute viral laryngitis: voice rest without whispering, fluids, humidified air and avoiding smoke; no antibiotics; laryngoscopy if it lasts beyond 3 weeks.
A 60-year-old heavy smoker has had a low, rough voice for months. Laryngoscopy shows both vocal folds swollen like water bags. What is it?
Reinke oedema (polypoid corditis); the key step is stopping smoking, with ENT follow-up and surgery for selected cases.
A man with cavitary lung TB has hoarseness, pain on swallowing and ear pain. Laryngoscopy shows ulcerated folds. What must be done besides treating TB?
Biopsy to exclude laryngeal cancer, airborne isolation because laryngeal TB is highly contagious, and HIV testing.
A newborn has a weak, hoarse cry and stridor. Laryngoscopy shows a membrane joining the front of the vocal folds. Which syndrome should be tested for?
22q11.2 deletion syndrome, present in about a third of children with a laryngeal web; check the heart too.
Elsewhere in DurgiPedia
- Bronchial obstruction syndrome
- The airway: from nose to bronchioles
- Airway defenses, cough and mucociliary clearance
Connections
See it in 3D5
The structures of Durgical's 3D anatomy where it is found.
Microorganisms5
In Pharmacology5
Educational content; it does not replace a medical assessment and is not a clinical instruction. For a real case, follow current guidelines and specialist advice.
Sources: Acute Laryngitis (StatPearls Publishing (NCBI Bookshelf), 2026); Dysphonia (StatPearls Publishing (NCBI Bookshelf), 2024); Laryngopharyngeal Reflux (StatPearls Publishing (NCBI Bookshelf), 2025); Epiglottitis (StatPearls Publishing (NCBI Bookshelf), 2024); Croup (StatPearls Publishing (NCBI Bookshelf), 2025); Hoarseness (National Institute on Deafness and Other Communication Disorders (NIDCD), NIH, 2017).
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Representative model, for educational purposes only.