CHILDREN'S HEALTH Ear/Nose/Throat • Earwax blockage • Acute sinusitis • Hearing loss • Chronic sinusitis • Tonsillitis • Ear infection, middle ear • Tinnitus • Laryngitis • Airplane ear • Swimmer's ear • Nasal polyps • Ruptured eardrum • Sore throat • Epiglottitis • Benign paroxysmal positional vertigo (BPPV) • Meniere's disease • Nonallergic rhinitis

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Laryngitis is an inflammation of your voice box (larynx) due to overuse, irritation or infection. The larynx is a framework of cartilage, muscles and mucous membranes that forms the entrance of your windpipe (trachea). Inside the larynx are your vocal cords — two folds of mucous membrane covering muscle and cartilage.

Normally your vocal cords open and close smoothly, forming sounds through their movement and vibration. But in laryngitis, your vocal cords become inflamed or irritated. They swell, causing distortion of the sounds produced by air passing over them. As a result, your voice sounds hoarse. In some cases of laryngitis, your voice can become so faint as to be undetectable.

Laryngitis may be short-lived (acute) or long-lasting (chronic). Although acute laryngitis usually is nothing more than an irritation and inflammation from a virus, persistent hoarseness can signal a more serious problem.

Laryngitis often makes you feel the need to constantly clear your throat. Other signs and symptoms may include:

• Hoarseness
• Weak voice
• Tickling sensation and rawness of your throat
• Sore throat
• Dry throat
• Dry cough

Usually a viral infection causes acute laryngitis. A bacterial infection such as diphtheria also may be the cause, but this is rare. Acute laryngitis may also occur during the course of or after another illness, such as a cold, flu or pneumonia.

Common causes of chronic laryngitis include constant irritation from excessive alcohol, heavy smoking or reflux of stomach acid into the esophagus and throat, a condition called gastroesophageal reflux disease (GERD).

In adults, other causes of chronic hoarseness may include:

• Sores (contact ulcers) on the vocal cords
• Growths (polyps or nodules) on the vocal cords
• Loosening of vocal cords due to aging
• Vocal cord paralysis, which can result from injury, stroke or a lung tumor

The following factors place you at greater risk of developing laryngitis:

• Having a respiratory infection, such as a cold, influenza, bronchitis or sinusitis
• Exposure to irritating substances, such as cigarette smoke, excessive alcohol, stomach acid or workplace chemicals
• Overusing your voice, by speaking too much, speaking too loudly, shouting or singing

Laryngitis is usually a temporary problem that either improves by itself or clears after treatment. You can manage most acute cases of laryngitis with self-care steps, such as resting your voice, drinking plenty of fluids and sucking on lozenges. If hoarseness lasts for more than two weeks in an adult or more than one week in a child, see your doctor.

If your child develops laryngitis and has a high fever, won't eat or drink, is drooling excessively, or has trouble breathing, see your doctor right away. Children younger than age 4 who have laryngitis may have croup — inflammation of the larynx and the airway just beneath it. Croup causes a loud barking cough and typically a hoarse voice.

The primary sign of laryngitis is hoarseness. Changes in your voice can vary with the degree of infection or irritation, ranging from mild hoarseness to almost total loss of your voice. Your doctor may ask whether you smoke or if you have any health conditions — such as a cold, influenza or allergies — that may be causing vocal irritation. Your doctor may also ask you whether any overuse of your vocal cords — such as singing or shouting — may have irritated your vocal cords.

If you have chronic hoarseness, your doctor may want to listen to your voice and to visualize your vocal cords or refer you to an ear, nose and throat specialist (otolaryngologist). Your doctor can use these techniques to help diagnose laryngitis:

• Laryngoscopy. Your doctor can visually examine your vocal cords in a procedure called laryngoscopy, by using a light and a tiny mirror to look into the back of your throat. Or your doctor may use fiber-optic laryngoscopy. This involves inserting a thin, flexible tube (endoscope) with a tiny camera and light through your nose or mouth and into the back of your throat. Then your doctor can watch the motion of your vocal cords as you speak.
• Biopsy. If your doctor sees a suspicious area, your doctor may do a biopsy — taking a sample of tissue for examination under a microscope.

Treatment depends on the cause of the laryngitis. The best treatment for the most common cause, a virus, is to rest your voice as much as possible and avoid clearing your throat. If an inhaled irritant is to blame, avoid the irritant. It may also help to inhale steam from a bowl of hot water or warm shower.

If your infant or toddler has laryngitis associated with croup, your child's doctor may prescribe a corticosteroid such as dexamethasone.

For chronic laryngitis associated with other conditions, such as heartburn, smoking or alcoholism, managing the underlying condition is necessary for improvement.

If you smoke, stop. In addition, if you're a smoker and develop persistent hoarseness, see your doctor and get a thorough examination of your vocal cords to be sure cancer isn't present. Detected early, cancer of the larynx generally can be successfully treated with surgery or radiation.

If alcohol consumption is responsible for your laryngitis, stop drinking. If you can't voluntarily give up alcohol, get treatment to help.

To prevent dryness or irritation to your vocal cords:

• Don't smoke, and avoid secondhand smoke. Smoke dries your throat and irritates your vocal cords.
• Drink plenty of water. Fluids help keep the mucus in your throat thin and easy to clear.
• Limit alcohol and caffeine to prevent a dry throat. If you have laryngitis, avoid both substances.
• Avoid clearing your throat. This does more harm than good, because it causes an abnormal vibration of your vocal cords and can increase swelling. Clearing your throat also causes your throat to secrete more mucus and feel more irritated, making you want to clear your throat again.

The following self-care steps may relieve the symptoms of laryngitis and reduce strain on your voice:

• Moisten your throat. Try sucking on lozenges, gargling with salt water or chewing a piece of gum.
• Use a humidifier. Keep the air throughout your home moist.
• Avoid talking or singing too loudly or for too long. If you need to speak before large groups, try to use a microphone or megaphone.
• Give your voice a break. Rest your voice when possible.
• Seek voice training. Consider this if you're a singer or if your voice quality is important.
• Avoid whispering. This puts even more strain on your voice than does normal speech.