1 of 26

Course: Medical Surgical Nursing

Topic: Laryngitis

The Nurses International Community

Contact info: info@nursesinternational.org

2 of 26

COPYRIGHT

NI Privacy Policy and Terms of Use.

Contact info: info@nursesinternational.org

3 of 26

Module Goals

Learners will be able to:

Describe the clinical manifestation of Laryngitis.
Discuss the assessment and diagnostic findings of Laryngitis.
Discuss the complications of acute Laryngitis.
Describe the medical management of Laryngitis.
Discuss the nursing management of Laryngitis.

Contact info: info@nursesinternational.org

4 of 26

Laryngitis

Inflammation of the larynx (acute and chronic types)

Acute laryngitis is often mild and self-limiting.

Typically lasts 3 to 7 days

Chronic laryngitis lasts over 3 weeks

Healthline, 2022

Contact info: info@nursesinternational.org

5 of 26

Laryngitis (Continued)

Contact info: info@nursesinternational.org

6 of 26

Laryngitis: Etiology

Classified as either infectious or non-infectious

Infectious: more common and usually follows an upper respiratory tract infection.

Potential causes:

rhinovirus
parainfluenza virus
respiratory syncytial virus
coronavirus
adenovirus
influenza

Mahajan, 2021

Contact info: info@nursesinternational.org

7 of 26

Laryngitis: Etiology (Continued)

The non-infectious causes

Vocal trauma (abuse,misuse)
Allergy
Gastroesophageal reflux disease
Asthma
Environmental pollution
Smoking
Inhalational injuries
Functional/conversion disorders

Mahajan, 2021

Contact info: info@nursesinternational.org

8 of 26

Laryngitis: Etiology (Continued)

Bacterial superinfection may occur in the setting of viral laryngitis.

This usually occurs seven days after symptoms begin.

Laryngitis caused by fungal infection is very rare.

More often presents as chronic laryngitis in the immunocompromised or in patients using inhaled steroid medications.

Mahajan, 2021

Contact info: info@nursesinternational.org

9 of 26

Laryngitis: Etiology (Continued)

Acute Laryngitis

Viral Infections
Straining the vocal cords by talking or yelling
Bacterial infections
Drinking excess alcohol

Chronic Laryngitis

Frequent exposure to harmful chemicals or allergens.
Acid reflux
Smoking or being around smokers
Voice overuse
Low-grade yeast infections caused by frequent use of an asthma inhaler.

Healthline, 2022

Contact info: info@nursesinternational.org

10 of 26

Laryngitis: Clinical Manifestations

Weakened voice
Aphonia (loss of voice)
Hoarse, dry throat
Constant tickling or minor throat irritation
Dry, severe cough
Discomfort and pain in the throat, particularly after talking
Dysphagia (difficulty swallowing)
Odynophagia (painful swallowing)

Mahajan, 2021

Contact info: info@nursesinternational.org

These symptoms are usually mild and can be treated by giving the voice a break. Drinking water or other non-caffeinated fluids can help lubricate your throat.

Pathophysiology:

Acute laryngitis resolves within 2 weeks, and is due to local inflammation of the vocal folds and surrounding tissues in response to a trigger, whether that trigger is infectious or non-infectious. If symptoms persist beyond this timeframe it is either due to superinfection or due to a transition to chronic laryngitis.

Acute laryngitis is characterized by inflammation and congestion of the larynx in the early stages. This can encompass the supraglottic, glottic, or subglottic larynx (or any combination thereof), depending on the inciting organism. As the healing stage begins, white blood cells arrive at the site of infection to remove the pathogens. This process enhances vocal cord edema and affects vibration adversely, changing the amplitude, magnitude, and frequency of the normal vocal fold dynamic. As the edema progresses, the phonation threshold pressure can increase. The generation of adequate phonation pressure becomes more difficult, and the patient develops phonatory changes both as a result of the changing fluid-wave dynamics of the inflamed and edematous tissue, but also as a result of both conscious and unconscious adaptation to attempt to mitigate these altered tissue dynamics. Sometimes edema is so marked that it becomes impossible to generate adequate phonation pressure. In such a situation, the patient may develop frank aphonia. Such maladaptations may result in prolonged vocal symptoms after an episode of acute laryngitis that can persist long after the inciting event has resolved. In such situations, referral to an otolaryngologist and/or speech-language pathologist is warranted.

(Mahajan, 2021)

11 of 26

Case Study

A 45-yr-old client with asthma complains of persistent hoarseness for 4 weeks. The client is referred to the ENT surgeon, who examined the larynx. A small red nodule is visualized on the client’s right vocal cord. After several weeks, the client returned to the ENT surgeon with worsening hoarseness. At this time, a micro laryngoscopy showed an inflamed, bulky right vocal cord covered with white debris. A sample was taken showing an Aspergillus infection causing laryngitis.

Classify this condition based on the duration of symptoms
State whether the client suffers from infectious or non-infectious laryngitis.

Contact info: info@nursesinternational.org

12 of 26

Laryngitis: Assessment and Diagnostic Findings

Routinely made via a thorough history and physical examination.
Formal voice analysis and fiberoptic laryngoscopy used to confirm the diagnosis.
Stroboscopy
Further imaging or laboratory studies are not required unless atypical pathogen or neoplasm are suspected.
If the client has exudate in the oropharynx or vocal cords, culture may be indicated.

Mahajan, 2021

Contact info: info@nursesinternational.org

13 of 26

Laryngitis:

Assessment and Diagnostic Findings (Continued)

A laryngoscopy might be performed to magnify the voice box for easy viewing.

The doctor uses a thin, flexible tube with a microscopic camera through the mouth or nose to look for:

irritation
redness
lesions on the voice box
widespread swelling
vocal cord swelling

Healthline, 2022

Contact info: info@nursesinternational.org

14 of 26

Stroboscopy

Contact info: info@nursesinternational.org

15 of 26

Laryngoscopy

Contact info: info@nursesinternational.org

16 of 26

Laryngitis: Complications

Respiratory distress (requires immediate medical attention)
Epiglottitis
Vocal cord paralysis
Pneumonia
Throat cancer

Healthline, 2022

Contact info: info@nursesinternational.org

17 of 26

Case Study

A 45-yr-old client with asthma complains of persistent hoarseness for 4 weeks. The client is referred to the ENT surgeon, who examined the larynx. A small red nodule is visualized on the client’s right vocal cord. After several weeks, the client returned to the ENT surgeon with worsening hoarseness. At this time, a micro laryngoscopy showed an inflamed, bulky right vocal cord covered with white debris. A specimen was taken showing an Aspergillus infection causing laryngitis.

Describe the complications of laryngitis.
Explain the difference between stroboscopy and laryngoscopy

Contact info: info@nursesinternational.org

18 of 26

Laryngitis: Medical Management

In most cases, laryngitis resolves within a week without treatment.

Narrow-spectrum antibiotics given only in the presence of identifiable gram stain and culture.

Mahajan, 2021

Contact info: info@nursesinternational.org

19 of 26

Laryngitis: Nursing Management

Client Education:

Voice rest
Drink plenty of water to keep the throat moist
Reduce coffee and alcohol consumption
Avoid clearing the throat (it may cause more irritation)
If there is cough that is dry and does not produce mucus, take an over-the-counter cough suppressant (as recommended by the doctor)

Mahajan, 2021

Contact info: info@nursesinternational.org

20 of 26

Laryngitis: Nursing Management (Continue)

If antibiotics are prescribed, take them as directed.
Use saline nasal washes to help keep the nasal passages open and wash out mucus and bacteria.
Avoid smoking and smoke exposure.
Use menthol inhalation and air humidifiers.
Avoid:

caffeinated drinks
spicy food items
fatty food
chocolate
peppermint
late meals

MyHealth.Alberta.ca. 2022

Contact info: info@nursesinternational.org

21 of 26

Case Study

A 45-yr-old client with asthma has been complaining of persistent hoarseness for 4 weeks. The client is referred to the ENT surgeon, who examined the larynx. A small red nodule is visualized on the client’s right vocal cord. After several weeks, the client returned to the ENT surgeon with worsening hoarseness. At this time, a micro laryngoscopy showed an inflamed, bulky right vocal cord covered with white debris. A sample was taken showing an Aspergillus infection causing laryngitis.

Describe the nursing management for this client

Contact info: info@nursesinternational.org

22 of 26

Vocal Therapy

Vocal therapy is a type of speech and language therapy that involves studying voice usage and how it may contribute to the symptoms.

Information and advice about voice changes and exercises are taught to prevent further damage to the larynx.

Contact info: info@nursesinternational.org

23 of 26

Cultural Considerations

Religion, culture, beliefs, and ethnic customs can influence how families understand and use health concepts:

Health beliefs: In some cultures talking about a possible poor health outcome will cause that outcome to occur.
Health customs: In some cultures family members play a large role in health care decision-making.
Ethnic customs: Differing gender roles may determine who makes decisions about accepting & following treatment recommendations.

AHRQ, 2020

Contact info: info@nursesinternational.org

24 of 26

Cultural Considerations (Continued)

Religion, culture, beliefs, and ethnic customs can influence how families understand and use health concepts:

Religious beliefs: Faith and spiritual beliefs may affect health seeking behavior and willingness to accept treatment.
Dietary customs: Dietary advice may be difficult to follow if it does not fit the foods or cooking methods of the family.
Interpersonal customs: Eye contact or physical touch may be ok in some cultures but inappropriate or offensive in others.

AHRQ, 2020

Contact info: info@nursesinternational.org

25 of 26

References

Agency for Healthcare Research. (2020). Health Literacy Universal Precautions Toolkit, 2nd Edition. https://www.ahrq.gov/health-literacy/improve/precautions/tool10.html

Healthline. (2022). Laryngitis. https://www.healthline.com/health/laryngitis-2

Gupta G., & Mahajan, K. (2021) Acute Laryngitis. In: StatPearls (Ed). Treasure Island (FL): StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK534871/#_NBK534871_pubdet_

MyHealth.Alberta.ca. (2022). https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=uf7938

NHS Inform. (2022). Laryngitis. https://www.nhsinform.scot/illnesses-and-conditions/ears-nose-and-throat/laryngitis#treating-laryngitis

Contact info: info@nursesinternational.org

26 of 26

Please go to

My Learning Experience

to provide feedback on your experience.

Thank you, and come back soon!

Contact info: info@nursesinternational.org