Laryngitis

Case history #1

A 45-year-old man presents with hoarseness for 5 days, cough, and pain on swallowing. He has no fever but complains of increased mucus in his throat and occasional difficulty breathing. He has no prior history of hoarseness, surgery to the larynx, intubation, or vocal abuse. He has slight throat pain but denies reflux symptoms. On examination, there is no acute respiratory distress. His oral cavity is within normal limits, but the oropharynx shows hyperemia. The tonsils are slightly enlarged and erythemic. Mirror examination of the larynx reveals diffuse edema and erythema of the laryngeal structures, with increased mucus in the glottis. The airway is patent. There are no lesions involving the true vocal folds, and they are both mobile.

Case history #2

A 45-year-old man has hoarseness for the past 3 weeks, accompanied by painful swallowing and cough. He has no fever and states he has lost 2.5 kg over the last 3 months. He is known to be HIV-positive. Indirect laryngoscopy reveals an exophytic lesion on the left true vocal fold, with edema of both true vocal folds.

Other presentations

Diphtheria is encountered rarely in the US but can still infect children and adults who are immunocompromised or have not received vaccinations. Initial symptoms include hoarseness and sore throat. There is progressive shortness of breath as the patient becomes generally ill. On examination, the patient is toxic. Oral examination reveals white-gray exudates on the tonsils and the soft palate, extending down to the base of tongue.

Other less common causes of infectious laryngitis include syphilis and fungal infection. In patients who are using corticosteroid inhalers, the onset of hoarseness should raise the suspicion for possible laryngeal candidiasis. Patients with laryngitis due to vocal trauma will have an accompanying history of increased voice use and high vocal demands.