Laryngitis

Laryngitis is the most common cause of acute hoarseness. It is secondary to diffuse swelling of the larynx. Viral infections are the most common cause and are often associated with other upper respiratory tract symptoms. Treatment is conservative, and recommendations include relative voice rest and avoidance of inhalational substances such as cigarette smoke or other irritating substances. Humidification may be helpful. Symptoms from viral laryngitis usually improve within days; if hoarseness persists longer than the typical several days, the physician should consider other causes, such as bacterial infection with respiratory organisms (e.g., M. catarrhalis, H. influenzae). For this reason, a course of antibiotics directed at these pathogens may be helpful, especially if symptoms persist even after conservative treatment.

Other uncommon infectious causes of laryngitis include tuberculosis and syphilis. Fungal infections can also localize to the larynx. Of these, Candida albicans is the most common and is found in immunocompromised patients, patients using inhaled steroids, and those using long-term, broad-spectrum antibiotics. Characteristic findings on examination include a diffuse reddened mucosa covered by white patches. Topical treatment includes nystatin, micon-azole, or clotrimazole; systemic therapy includes fluconazole or ketoconazole.

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