ORIGINAL ARTICLE
Acute infectious laryngitis:
A case series
Aaron J. Jaworek, MD; Kranthi Earasi, MD; Karen M. Lyons, MD;
Srihari Daggumati, BS; Amanda Hu, MD, FRCSC; Robert T. Sataloff, MD, DMA, FACS
Abstract
Although acute laryngitis is common, it is often man-
aged by primary physicians. Therefore, video images
documenting its signs are scarce. This series includes 7
professional voice users who previously had undergone
baseline strobovideolaryngscopy (SVL) during routine
examinations or during evaluations for other complaints
and who returned with acute laryngitis. Sequential SVL
showed not only the expected erythema, edema, cough,
and dysphonia, but also new masses in 5 of the 7 sub-
jects. All the signs returned to baseline. This series is re-
ported to highlight the reversible structural changes that
can be expected in patients with acute laryngitis and the
value of conservative management.
Introduction
Acute infectious laryngitis is one of the most com-
mon disorders of the larynx and is often associated
with upper respiratory tract infections (URIs), as
reported more than a decade ago in a Cochrane re-
view.1 Laryngeal inflammation can cause hoarseness,
sore throat, and difficulty swallowing. These symp-
toms usually subside within 3 weeks but may persist
much longer (months).
It can be difficult to distinguish between bacterial
and viral origins.1 Viral laryngitis can be caused by
many organisms, including but not limited to, influ-
enza virus, adenovirus, and even Varicella zoster virus.
Acute bacterial laryngitis presents similarly; however,
purulent secretions are observed more commonly in
patients with a bacterial infection.2 Treatment for viral
From the Department of Otolaryngology–Head and Neck Surgery,
Drexel University College of Medicine, Philadelphia (Dr. Jaworek,
Dr. Lyons, and Dr. Sataloff); Specialty Physician Associates,
Bethlehem, Pa. (Dr. Jaworek); Drexel University College of Medicine,
Philadelphia (Dr. Earasi and Mr. Daggumati); and the Department
of Otolaryngology–Head and Neck Surgery, the University of British
Columbia, Vancouver (Dr. Hu). The cases described in this article
occurred at Drexel University College of Medicine.
Corresponding author: Robert T. Sataloff, MD, DMA, FACS, 219 N.
Broad St., 10th Floor, Philadelphia, PA 19107. Email: RTSataloff@
PhillyENT.com
306 www.entjournal.com
causes remains supportive, with adequate hydration
and at least relative voice rest, while the bacterial form
may benefit from the addition of an antibiotic.
Most patients with URI symptoms are evaluated
and treated by a primary care physician. It is much
less common for the otolaryngologist to treat an acute
episode unless there is a complicating feature (e.g.,
protracted course, persistent symptoms after the URI,
recurrent episodes, etc.). For this reason, high-quality
images of the larynx during an acute infection often are
not available. We present a series of patients with acute
infectious laryngitis and their coinciding laryngoscopic
images to highlight salient features.
Each patient presented here was established within
the practice and had had strobovideolaryngoscopy
performed before, during, and after an acute episode
of infectious laryngitis.
The examinations performed before the current visits
often were performed routinely at the patient’s request,
to establish the normal baseline appearance of their
vocal folds when they were healthy. In some cases, they
were performed incidentally during evaluation for other
complaints, but none was performed for laryngitis or
any other acute laryngeal problem. These examinations
established the “normal” basline laryngoscopic appear-
ance for each of these patients.
Case reports
Patient 1. A 37-year-old woman presented with a his-
tory of cough for 1 week and a gradual onset of hoarse-
ness that began 2 days before the visit. These symp-
toms progressed to aphonia for 3 days and a sensation
of throat swelling. Strobovideolaryngoscopy (SVL) re-
vealed a new right mid-membranous vocal fold mass,
moderate erythema and edema of the true vocal folds
and arytenoids, and thick mucopurulent secretions
(figure 1, A). The proximal trachea also appeared in-
flamed. Acute laryngotracheitis was diagnosed, and
amoxicillin-clavulanate and prednisone were pre-
scribed for 7 days.
ENT-Ear, Nose & Throat Journal September 2018
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 Jaworek, Earasi, Lyons, Daggumati, Hu, Sataloff
Figure 1. Patient 1 during acute infectious laryngitis episode (A)
and after resolution of the laryngitis (B).
Follow-up SVL 8 days later demonstrated resolution
of the patient's right vocal fold mass, and the true vocal
folds were no longer erythematous. The appearance of
her arytenoids and consistency of her secretions had
returned to baseline (figure 1, B).
Patient 2. A 29-year-old man experienced hoarseness
that progressed to aphonia 4 days before his office visit.
Cough, increased mucus production, and a sensation of
swelling of the throat were reported, as well. SVL revealed
moderate edema and severe erythema of the arytenoids,
and erythema and edema of the true vocal folds with
increased vascularity (figure 2, A). Thick mucus was visu-
alized in the larynx, as well as bilateral mid-membranous
inflammatory masses with an exudative appearance. A
diagnosis of acute infectious laryngitis was made, and
amoxicillin-clavulanate was prescribed for 7 days.
Figure 2. Patient 2 during acute infectious laryngitis episode (A)
and after resolution of the laryngitis (B).
SVL 3 weeks later demonstrated resolution of the acute
changes, and only the baseline pathology remained,
which included laryngopharyngeal reflux (LPR) and
vocal fold scar (figure 2, B).
Patient 3. A 17-year-old female singer had a history
of vocal fold nodules and reflux laryngitis. She report-
ed a productive cough for the previous 24 hours. SVL
revealed edema of the true vocal folds and erythema
of the larynx. Thick yellow mucus was observed from
within the trachea (figure 3, A). A diagnosis of acute
laryngotracheitis was made, and the patient was started
on amoxicillin-clavulanate for 10 days.
Figure 3. Patient 3 during acute infectious laryngitis episode (A)
and after resolution of the laryngitis (B).
308 www.entjournal.com
The patient did not return until 15 weeks later, at
which time SVL confirmed resolution of the infection
(figure 3, B).
Patient 4. A 35-year-old woman presented with acute
hoarseness and cough of 1 to 2 weeks’ duration. SVL re-
vealed moderate erythema and edema of the arytenoids
and Reinke edema. Severe inflammation was observed
involving the true vocal folds, subglottis, trachea, and
the interarytenoid region (figure 4, A). Purulent secre-
tions were evident, and amoxicillin-clavulanate was
prescribed for 7 days.
Figure 4. Patient 4 during acute infectious laryngitis episode (A)
and after resolution of the laryngitis (B).
Follow-up 3 weeks later with SVL revealed improve-
ment in Reinke edema, erythema of the larynx and
trachea, and the consistency of secretions (figure 4, B).
Patient 5. A 34-year-old man presented with
hoarseness and cough for 2.5 weeks. His voice had
deteriorated gradually over the previous few days to
a whisper. SVL revealed new lesions on the posterior
third of each musculomembranous vocal fold that ap-
peared inflammatory (figure 5, A). A diagnosis of acute
laryngitis was made, and the patient was treated with
amoxicillin for 14 days. Fluconazole and nystatin were
prescribed empirically to treat suspected superimposed.
fungal laryngitis, especially since prednisone also was
prescribed for 2 weeks to help with the inflammation.
Figure 5. Patient 5 during acute infectious laryngitis episode (A)
and after resolution of the laryngitis (B).
The patient returned 1 week later for follow-up. SVL
revealed resolution of the true vocal fold lesions and
accompanying erythema and edema (figure 5, B). The
patient’s hoarseness also had improved markedly.
Patient 6. A 31-year-old woman presented with sore
throat, odynophagia, hoarseness, and a cough produc-
tive of yellow sputum for 1 week. She reported vocal
fatigue, reduced projection, and loss of range when
ENT-Ear, Nose & Throat Journal September 2018
 Jaworek, Earasi, Lyons, Daggumati, Hu, Sataloff
singing. She had been staying hydrated and taking a
decongestant, expectorant, and cough suppressant.
SVL revealed three areas of swelling along the vibra-
tory margin of the left vocal fold with a “tongue and
groove” effect along the contralateral vocal fold. There
were prominent vessels along this patient’s vocal folds,
and her larynx appeared erythematous (figure 6, A).
Decreased mucosal wave and vibration of the true
vocal folds were observed. The patient was treated
with amoxicillin-clavulanate for 10 days along with
guaifenesin for congestion.
Figure 6. Patient 6 during acute infectious laryngitis episode (A)
and after resolution of the laryngitis (B).
The patient returned 7 weeks later for follow-up. At
that time, she reported that she had had a sore throat
for the previous week and that she had begun coughing
up yellow sputum. She was treated with levofloxacin for
7 days and oseltamivir for 5 days. When she returned
3 weeks later, follow-up SVL showed resolution of her
inflammatory masses, and the mucosal wave and vi-
bratory characteristics of the vocal folds had returned
to baseline (figure 6, B).
Patient 7. A 29-year-old woman presented with an
acute episode of hoarseness progressing to aphonia,
which she had experienced 3 days before her appoint-
ment. She also reported a sore throat, odynophagia, and
cough for 5 days. She had been taking a cough suppres-
sant, antihistamine, decongestant, and acetaminophen
to relieve her symptoms, and she had increased oral
hydration. SVL revealed increased Reinke edema and
new bilateral mid-membranous vocal fold masses (figure
7, A). The amplitude and wave form of the vocal folds
were decreased. She was diagnosed with acute laryngitis
and treated with amoxicillin-clavulanate for 10 days
and a methylprednisolone taper.
Figure 7. Patient 7 during acute infectious laryngitis episode (A)
and after resolution of the laryngitis (B).
310 www.entjournal.com
At follow-up 1 week later, the patient’s voice had
improved markedly. She reported that she had been
able to speak “normally” after 5 days of treatment.
SVL revealed resolution of the inflammatory vocal fold
masses, return to baseline of laryngeal erythema and
edema, and the vibratory characteristics of the vocal
folds had improved. (figure 7, B).
Summary of symptoms
On presentation, all 7 patients reported hoarseness,
6 had cough, 3 had increased mucus/phlegm, and 3
had aphonia. SVL revealed laryngeal edema and ery-
thema in all 7 patients, a new vocal mass in 5 patients
compared with their baseline examinations, increased
mucus in 4 patients, and tracheal involvement in 3 pa-
tients. The duration of symptoms before and after the
patients’ initial visits is shown in figure 8.
Discussion
These 7 patients provided novel insights into the pre-
sentation of acute infectious laryngitis. Of particular
interest was the development of acute inflammatory
vocal fold masses along the vibratory margin and in-
creased laryngeal edema and erythema compared to
baseline. Voice change and laryngeal edema and er-
ythema were present in all 7 patients. Cough was a
presenting symptom in 6, and new vocal fold masses
along the vibratory margin were present in 5 patients.
An increased amount of thick mucus involving the
larynx was observed in 4 patients, with additional pa-
tients reporting a productive cough. The duration of
symptoms ranged from 15 days to 35 days. The mean
time to symptom resolution after initiation of medical
therapy was 16 days. Follow up SVL confirmed resolu-
tion of the acute findings in all 7 patients.
Acute infectious laryngitis is characterized by in-
flammation of the larynx that usually resolves within
3 weeks. The condition often accompanies upper respi-
ratory tract infections with symptoms that may include
hoarseness, sore throat, odynophonia, odynophagia,
dysphagia, dyspnea, cough, congestion, postnasal drip,
and mucus. The hoarseness often is accompanied by
lowering of pitch that persists for 3 to 8 days in most
cases.1 The voice may sound breathy and/or raspy, and
compensatory muscle tension dysphonia often is present.
SVL frequently reveals erythema and edema of the
larynx involving the true vocal folds, resulting in
alteration of the mucosal wave and vibratory charac-
teristics. Inflammatory masses also can develop on the
true vocal folds, further exacerbating the dysphonia
and altered pitch.
Acute infectious laryngitis is caused by numerous
pathogens. Among these, viral pathogens are believed
to be most prevalent, following patterns similar to
ENT-Ear, Nose & Throat Journal September 2018
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INDICATIONS
OTOVEL® (ciprofloxacin and fluocinolone acetonide) is indicated for the treatment of acute otitis media
with tympanostomy tubes (AOMT) in pediatric patients (aged 6 months and older) due to S. aureus,
S. pneumoniae, H. influenzae, M. catarrhalis, and P. aeruginosa.

IMPORTANT SAFETY INFORMATION

Contraindications
OTOVEL is contraindicated in:
• Patients with known hypersensitivity to fluocinolone acetonide or other corticosteroids, ciprofloxacin
or other quinolones, or to any other component of OTOVEL.
• Viral infections of the external ear canal, including varicella and herpes simplex infections and fungal
otic infections.
The following Warnings and Precautions have been associated with OTOVEL: hypersensitivity reactions,
potential for microbial overgrowth with prolonged use, and continued or recurrent otorrhea.
The most common adverse reactions are otorrhea, excessive granulation tissue, ear infection, ear
pruritis, tympanic membrane disorder, auricular swelling, and balance disorder.
For additional Important Safety Information, please see Brief Summary of Prescribing Information
on adjacent page, and full Prescribing Information available at www.otovel.com.
References: 1. Otovel [package insert]. Atlanta, GA: Arbor Pharmaceuticals, LLC. 2016. 2. Data on file. Arbor Pharmaceuticals, LLC. 3. Guidance Otovel is a registered trademark of Laboratorios
for industry: sterile drug products produced by aseptic processing—current good manufacturing practice. Food and Drug Administration. Salvat, S.A. with the US Patent and Trademark
Office and under license by Arbor
https://www.fda.gov/downloads/Drugs/Guidances/ucm070342.pdf. Published September 2004. Accessed March 15, 2018. 4. Orange Book:
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Approved drug products with therapeutic equivalence evaluations. US Food and Drug Administration. https://www.accessdata.fda.gov/scripts/
property of their respective owners.
cder/ob/default.cfm. Updated May 17, 2013. Accessed July 15, 2016. 5. Spektor Z, Pumarola P, Ismail K, et al. Efficacy and safety of ciprofloxacin
plus fluocinolone in otitis media with tympanostomy tubes in pediatric patients: a randomized clinical trial. JAMA Otolaryngol Head Neck Surg. © 2018 Arbor Pharmaceuticals, LLC. All rights
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OTOVEL® (ciprofloxacin and fluocinolone acetonide) otic solution
Table 1: Selected Adverse Reactions that Occurred in 1 or more Patients in the
Brief Summary of Prescribing Information
OTOVEL Group
1 INDICATIONS AND USAGE
OTOVEL is indicated for the treatment of acute otitis media with tympanostomy Number (%) of Patients
tubes (AOMT) in pediatric patients (aged 6 months and older) due to Staphylococcus
aureus, Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, OTOVEL CIPRO FLUO
and Pseudomonas aeruginosa. Adverse Reactions1 N=224 N=220 N=213

2 DOSAGE AND ADMINISTRATION Otorrhea 12 (5.4%) 9 (4.1%) 12 (5.6%)

• OTOVEL is for otic use only. It is not for ophthalmic use, or for injection. Excessive granulation tissue 3 (1.3%) 0 (0.0%) 2 (0.9%)
The recommended dosage regimen is as follows:
Ear infection 2 (0.9%) 3 (1.4%) 1 (0.5%)
• Instill the contents of one single-dose vial 0.25 mL into the affected ear canal
twice daily (approximately every 12 hours) for 7 days. Use this dosing for patients Ear pruritus 2 (0.9%) 1 (0.5%) 1 (0.5%)
aged 6 months of age and older.
Tympanic membrane disorder 2 (0.9%) 0 (0.0%) 0 (0.0%)
• Warm the solution by holding the vial in the hand for 1 to 2 minutes. This is to
avoid dizziness, which may result from the instillation of a cold solution into Auricular swelling 1 (0.4%) 1 (0.5%) 0 (0.0%)
the ear canal.
• The patient should lie with the affected ear upward, and then instill the Balance disorder 1 (0.4%) 0 (0.0%) 0 (0.0%)
medication.
• Pump the tragus 4 times by pushing inward to facilitate penetration of the Selected adverse reactions that occurred in ≥ 1 patient in the OTOVEL group derived
1

medication into the middle ear. from all reported adverse events that could be related to the study drug or the drug
class.
• Maintain this position for 1 minute. Repeat, if necessary, for the opposite ear
[see Instructions for Use]. 6.2 Postmarketing Experience
The following adverse reactions have been identified during postapproval use of
3 DOSAGE FORMS AND STRENGTHS ciprofloxacin and fluocinolone acetonide otic solution, 0.3% / 0.025% outside the US.
Otic Solution: Each single-dose vial of OTOVEL (ciprofloxacin 0.3 % and fluocinolone Because these reactions are reported voluntarily from a population of uncertain size,
acetonide 0.025 %) delivers 0.25 mL of solution equivalent to ciprofloxacin 0.75 mg it is not always possible to reliably estimate their frequency or establish a causal
and fluocinolone acetonide 0.0625 mg. relationship to drug exposure.
4 CONTRAINDICATIONS • Immune system disorders: allergic reaction.
OTOVEL is contraindicated in:
• Infections and infestations: candidiasis.
• Patients with known hypersensitivity to fluocinolone acetonide or other
corticosteroids, ciprofloxacin or other quinolones, or to any other components • Nervous system disorders: dysgeusia, paresthesia (tingling in ears), dizziness,
of OTOVEL. headache.

• Viral infections of the external ear canal, including varicella and herpes simplex • Ear and labyrinth disorders: ear discomfort, hypoacusis, tinnitus, ear congestion.
infections and fungal otic infections. • Vascular disorders: flushing.
5 WARNINGS AND PRECAUTIONS • Skin and subcutaneous tissue disorders: skin exfoliation.
5.1 Hypersensitivity Reactions
OTOVEL should be discontinued at the first appearance of a skin rash or any other • Injury, poisoning and procedural complications: device occlusion (tympanostomy
sign of hypersensitivity. Serious and occasionally fatal hypersensitivity (anaphylactic) tube obstruction).
reactions, some following the first dose, have been reported in patients receiving 8 USE IN SPECIFIC POPULATIONS
systemic quinolones. Some reactions were accompanied by cardiovascular 8.1 Pregnancy
collapse, loss of consciousness, angioedema (including laryngeal, pharyngeal or Risk Summary
facial edema), airway obstruction, dyspnea, urticaria and itching. Serious acute OTOVEL is negligibly absorbed following otic administration and maternal use is
hypersensitivity reactions may require immediate emergency treatment. not expected to result in fetal exposure to ciprofloxacin and fluocinolone acetonide
5.2 Potential for Microbial Overgrowth with Prolonged Use (12.3)].
Prolonged use of OTOVEL may result in overgrowth of non-susceptible bacteria and 8.2 Lactation
fungi. If the infection is not improved after one week of treatment, cultures should Risk Summary
be obtained to guide further treatment. If such infections occur, discontinue use and OTOVEL is negligibly absorbed by the mother following otic administration and
institute alternative therapy. breastfeeding is not expected to result in exposure of the infant to ciprofloxacin and
5.3 Continued or Recurrent Otorrhea fluocinolone acetonide.
If otorrhea persists after a full course of therapy, or if two or more episodes of 8.4 Pediatric Use
otorrhea occur within 6 months, further evaluation is recommended to exclude an OTOVEL has been studied in patients as young as 6 months in adequate and well-
underlying condition such as cholesteatoma, foreign body, or a tumor. controlled clinical trials. No major differences in safety and effectiveness have been
6 ADVERSE REACTIONS observed between adult and pediatric patients.
The following serious adverse reactions are described elsewhere in the labeling: 8.5 Geriatric Use
Hypersensitivity Reactions [see Warnings and Precautions (5.1)] Clinical studies of OTOVEL did not include sufficient numbers of subjects aged 65
6.1 Clinical Trials Experience years and over to determine whether they respond differently from younger subjects.
Because clinical trials are conducted under widely varying conditions, adverse Other reported clinical experience has not identified differences in responses
reaction rates observed in the clinical trials of a drug cannot be directly compared between the elderly and younger patients.
to rates in the clinical trials of another drug and may not reflect the rates observed 10 OVERDOSAGE
in practice. Due to the characteristics of this preparation, no toxic effects are to be expected
In clinical trials, 224 patients with AOMT were treated with OTOVEL for a median with an otic overdose of OTOVEL.
duration of 7 days. All the patients received at least one dose of OTOVEL. There were
220 patients who received at least one dose of ciprofloxacin (CIPRO) and 213 patients
Distributed by:
received at least one dose of fluocinolone acetonide (FLUO). The most common
Arbor Pharmaceuticals, LLC
adverse reactions that occurred in 1 or more patients are as follows:
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 Acute infectious laryngitis: A case series
Figure 8. Graph shows the duration of symptoms in the 7
patients before and after their visits. (Note: 6a and 6b represent
two separate episodes in the same patient. The total duration of
symptoms was not known for patients 3 and 6a.)
those for URI. They include parainfluenza, rhinovirus,
influenza virus, and adenovirus. Bacterial pathogens
that have been associated with acute laryngitis include
Moraxella catarrhalis, Haemophilus influenzae, and
Streptococcus pneumoniae, with M catarrhalis being
the most common.2 Extension to the larynx of an
infection involving the upper aerodigestive tract can
occur. In some cases, a sputum culture may be helpful
to direct therapy.
The treatment for viral and bacterial laryngitis
includes supportive measures. At least relative voice
rest, humidification, analgesics, and hydration should
be considered along with mucolytics, decongestants,
and glucocorticoid steroids. In addition, antibiotics
may be prescribed in cases in which a bacterial infec-
tion is suspected (e.g., tracheitis, purulent secretions,
immunocompromised state, protracted course, pos-
itive culture, etc.). They also may be used when the
etiology is uncertain but pressing voice commitments
are imminent.
A Cochrane Review completed in 2015 investigated
the benefits of antibiotic usage for acute laryngitis.3
After reviewing the only two placebo-controlled, ran-
domized trials that met their inclusion criteria, the
authors concluded that antibiotics appeared to have
no benefit; however, they acknowledged that one of
the studies demonstrated a significant reduction in
severity of reported vocal symptoms after 1 week on
erythromycin (vs. placebo) and a significant reduction
in cough after 2 weeks with antibiotics.1
Since the patients in our series were professional
voice users, expeditious return to baseline vocal func-
tion was a primary concern. Therefore, prescribing an
antibiotic was justified based on the conclusions of the
study included in the Cochrane Review, as well as on
the uncertainty of the etiology and the need for rapid
return to safe phonation.
Volume 97, Number 9
LPR, a chronic form of laryngitis, can have signs and
symptoms that overlap with those of acute infectious
laryngitis. The distinguishing features of reflux laryngitis
include a longer duration of symptoms (usually over
many weeks, months, or even years), exacerbating fac-
tors (symptoms with meals or certain foods and during
specific activities), response to proton pump inhibitor/H2
blocker, and erythema/edema commonly most promi-
nent on or isolated to the region of the arytenoids.4 When
the two pathologies coexist, it is prudent to allow the
acute laryngitis episode to resolve before making a final
assessment of the need for long-term treatment for the
reflux, but acute treatment of LPR is advisable to decrease
inflammation caused by both LPR and infection. When
any uncertainty in the diagnosis remains, a 24-hour pH
impedance test can be helpful.
Another form of chronic laryngitis, prolonged ulcer-
ative laryngitis, also has been and reported by the senior
author (RTS), among others.5 Symptoms and abnormal
SVL may persist for many weeks (up to 5 months or
longer in some cases). Antibiotics and corticosteroids
are ineffective, and the etiology remains unknown,
although the senior author suspects that biofilms may
play a role.
Conclusion
Acute infectious laryngitis presents commonly during
URI. Through SVL images, the changes along the mus-
culomembranous vocal folds have been defined clearly
and documented in this case series. Further investiga-
tion with prospective, randomized, controlled trials
is needed to improve our understanding of ways to
differentiate viral from bacterial causes, to determine
whether the structural changes seen in this series of
voice professionals also occur routinely in other pa-
tients, to help guide appropriate use or nonuse of an-
tibiotics without inappropriate delays awaiting culture
results (especially for voice professionals), and to iden-
tify the most effective treatment strategies in various
patient populations.
References
1. Reveiz L, Cardona AF, Ospina EG. Antibiotics for acute laryngitis
in adults. Cochrane Database Syst Rev 2007;2:CD004783
2. Dworkin JP. Laryngitis: Types, causes, and treatments.
Otolaryngol Clin North Am 2008;41(2):419-36.
3. Reveiz L, Cardona AF. Antibiotics for acute laryngitis in adults.
Cochrane Database Syst Rev 2015;5:CD004783
4. Joniau S, Bradshaw A, Esterman A, Carney AS. Reflux and
laryngitis: A systematic review. Otolaryngol Head Neck Surg
2007;136(5):686-92.
5. Sataloff RT. Common infections, inflammations and other
conditions: Management in singers and actors. In: Sataloff RT.
Professional Voice: The Science and Art of Clinical Care. 3rd ed.
San Diego: Plural Publications; 2005:809.
www.entjournal.com 313