Laryngitis - Laryngopedia

An infection or inflammation of the larynx. The cause of laryngitis can be viral, bacterial, or fungal (candida). Or it can result from acid reflux, cancer radiation therapy, surgery (as temporary post-operative inflammation), or an auto-immune disorder.

Chronic Bacterial Laryngitis

Chronic bacterial laryngitis is a laryngologic problem looking for a more definitive solution. Seen in persons who have undergone radiotherapy or who have an immune defect. The laryngitis can often be improved with antibiotics, but often recurs when antibiotics are discontinued. Sometimes chronic antibiotic administration is needed. Or, laryngeal irrigations.

Bacterial infection? (1 of 5)

This young man has an autoimmune disorder and is taking a immunomodulator drug. He has been chronically hoarse for months. Is this further auto-immunity or a chronic bacterial infection?

Yellow mucus (2 of 5)

Notice yellowish mucus in the subglottis and the intense erythema of the subglottis. Culture shows staph aureus.

Improvement (3 of 5)

After several weeks of dicloxacillin, voice is dramatically improved, as is the laryngeal appearance (compare with photo 1).

After several weeks of dicloxacillin, voice is improved — Improvement (3 of 5)

After several weeks of dicloxacillin, voice is dramatically improved, as is the laryngeal appearance (compare with photo 1).

Improved voice (4 of 5)

During voicing, excellent vibratory blur, correlating with his much improved voice.

Infection returns (5 of 5)

Some months after discontinuing antibiotics, hoarseness has returned along with infected mucus.

Candida laryngitis, before and after treatment

Candida laryngitis (1 of 4)

Severe laryngeal candidiasis, in a person using inhaled steroids at high dose. Standard light.

Candida laryngitis (2 of 4)

Closer view shows more clearly not only the white areas, but also surrounding inflammation. Standard light.

surrounding inflammation on vocal cords — Candida laryngitis (2 of 4)

Closer view shows more clearly not only the white areas, but also surrounding inflammation. Standard light.

Candida laryngitis, 15 days after starting treatment (3 of 4)

After 15 days of oral fluconazole. Obvious improvement, but incomplete resolution of tissue changes.

Candida laryngitis, several months later (4 of 4)

After longer-term fluconazole, along with reduction of inhaled steroid dose, complete resolution. Strobe light, closed phase of vibration at high vocal pitch.

Candida laryngitis (1 of 4)

Candida laryngitis (1 of 4)

Candidiasis in patient using inhaled steroids for asthma. Under standard light, the lesions are vague, hazy, and best seen anteriorly on the right cord (left of image).

Candida laryngitis (2 of 4)

Candida laryngitis (2 of 4)

Same patient, narrow-band illumination. This not only emphasizes vascularity, but brings out the candida colonies.

Candida laryngitis, after treatment (3 of 4)

Candida laryngitis, after treatment (4 of 4)

Candida laryngitis, after treatment (4 of 4)

Same post-treatment examination, under narrow-band illumination. Note that there are normal specks of mucus (such as at the arrows) in the view.

Candida laryngitis (1 of 3)

whitish discoloration on the left vocal cord — Candida laryngitis (1 of 3)

Elderly woman with a history of laryngeal amyloidosis requiring laser sculpting several years earlier. Now using high-dose inhaled steroids, antibiotics, and oral steroids for unrelated pulmonary problem. Marked increase of hoarseness, and whitish discoloration, especially of the left vocal cord (right of image).

Candida laryngitis (2 of 3)

Candida laryngitis (2 of 3)

Closer view of hazy white areas and irregular right cord margin (left of image), presumed to be candida overgrowth. Empiric treatment with fluconazole is justified, given history and findings.

Candida laryngitis, after starting treatment (3 of 3)

Candida laryngitis, after starting treatment (3 of 3)

Two weeks after starting fluconazole; the white areas are completely resolved. The patient’s voice had improved markedly within three or four days of starting the treatment.

Gradual Healing of Ulcerative Laryngitis

Ulcerative laryngitis (1 of 4)

Ulcerated area, free margin of both vocal cords. When diagnosed at this early stage, the patient is notified that recovery will likely require as much as six weeks.

Ulcerative laryngitis (2 of 4)

Same view, but using narrow band illumination to accentuate the ulcers.

1 month later: ulcerative laryngitis healing (3 of 4)

One month later, under narrow band illumination. Ulceration dramatically diminished.

3 months later: ulcerative laryngitis virtually all healed (4 of 4)

At three months, standard illumination. Virtually complete healing, with excellent return of voice. The prominent vascularity at area of ulcer will eventually fade.

Vocal Cord Ulcer

Vocal cord ulcer (1 of 2)

In a patient who had had hoarseness lasting several months, this inflammatory lesion of the right vocal cord (left of image) was identified. There is hazy leukoplakia surrounding a central intensely erythematous ulcer. It most resembles an aphthous ulcer, though these are not previously reported on the vocal cord, and this lesion's duration is longer than the typical aphthous ulcer.

Vocal cord ulcer (2 of 2)

Closer view, under narrow-band light. The vessel pattern looks inflammatory and not neoplastic. There is heaped-up leukoplakia surrounding the lesion. After this lesion persisted for more than four months, it was removed. Tissue examination showed inflammatory response and keratosis without atypia.