Laryngitis Sicca

Laryngitis sicca—or sicca syndrome of the larynx—is a condition of a severely dry laryngeal mucosa (surface tissue). Instead of the thin layer of abundant moisture that normally coats and “lubricates” the vocal cords for vibration, the mucus may become viscous, stringy, adherent, or even crusted.

The result can be hoarseness, increased vocal effort, throat clearing, dry cough, or a persistent sensation of irritation.

Causes

The condition may result from or be exacerbated by insufficient fluid intake and dehydration, very dry air, mouth breathing, medications with drying effects, systemic disorders such as Sjögren’s syndrome, and especially prior radiation therapy to the larynx for cancer. On examination, the larynx may look dry, with tenacious or crusted secretions that do not clear normally.

A history of radiation is a particularly common source of this condition. That is because as the radiation therapy kills the tumor it is targeting, it may also damage or destroy the larynx’s mucus-producing glands. These damaged glands may then produce less mucus, and mucus that is more proteinaceous and consequently more viscous and sticky. This viscous mucus can also be easily colonized by bacteria, and become crusted, especially in winter, when humidity indoors is lower.

A second kind of laryngitis sicca seems to accompany bacterial infection alone, apart from any use of radiation therapy. The mucus crusts become yellow or green, and the mucosa reddens with inflammation. Organisms have been cultured such as Staph and Klebsiella. These may just be colonizers, more than original cause of the laryngitis sicca adherent mucus and crusts. In some cases nothing grows on culture of the mucus and crusts.

Treatment

This is directed both at the cause when appropriate, and at restoring surface hydration—typically through generous fluid intake, humidification of room air especially during sleep, avoidance of drying medications when possible, and sometimes more intensive local moisturizing measures. Examples include inhalation of nebulized saline or even teaching the patient to irrigate “gargle” inside the larynx.

Antibiotic therapy may improve or resolve the problem, at least during the antibiotic course, though some cases seem stubbornly resistant to such treatment, even with several courses of broad-spectrum antibiotics. A trial may be appropriate, but persistence with antibiotics that do not resolve the problem suggests falling back to hydration, humidification, etc.