What Is The Best Medical Remedy For Laryngitis?
Laryngitis can be classified according to its etiological factor; it can be infectious or noninfectious, being the first one more common.
Laryngitis Caused by Viruses
Catarrhal Laryngitis: This is the most common type of laryngitis. The implied agents can be: rinovirus, being the most frequent, but also adenovirus, myxovirus, paramyxovirus, picornavirus, coronavirus. They are usually related to an upper respiratory tract affectation causing symptoms such as malaise, fever, cough, dysphonia in the absence of dyspnea (respiratory distress). The treatment consists in vocal rest, analgesics, antipyretics and a proper hydration.
Flu-like Laryngitis: Most cases present as a common catarrhal laryngitis, although in this case there is greater chance of affecting the epiglottis which will cause respiratory distress. It is produced by influenza flu type A and B viruses. The proper treatment implies the same measures as the previous case.
Herpetic Laryngitis:
Herpes Simplex Type I and II virus: This is a particular type of laryngitis that only patients with immunosuppression may have. They present vesicles or ulcers in the laryngeal mucosa. The treatment will include antivirals such as Aciclovir.
Epstein-Barr (etiological agent of infectious mononucleosis): This virus can also affect the larynx. The treatment is indicated according to the symptoms.
Laryngitis Caused by Bacteria
Laryngitis Caused by Mycoplasma: Produced by Mycoplasma pneumoniae, that besides of producing pneumonia can cause an associated laryngotracheitis. Symptoms are fever, dry cough, odynophagia, dysphonia or even aphonia. Antibiotics such as erythromycin, clarithromycin or azithromycin are efficient in the treatment, but given to the self-limited course of Mycoplasma infection the treatment is symptomatic.
Diphtheritic Laryngitis: This is originated by the Corynebacterium diphtheriae toxins. Symptoms include fever, cough, rhinitis and angina, the pharynx and larynx can be affected presenting erythema and edema in their mucous. 24-48 later a gray adherent membrane is observed. Treatment is based in Penicillin and other general measures.
Laryngitis Caused by Fungi
-Laryngitis Caused by Candida: The most common causal agents are Candida albicans and Candida tropicalis. This form of laryngitis is rare if there are not predisposing factors such as the use of corticoids or spread spectrum antibiotics, diabetes mellitus, alcoholism, prolonged intubation, and especially in immunosuppression. Sometimes it is diagnosed very late because of its similarity with leukoplakia. The treatment consists in controlling factors of risk, it must include oral antifungal for a minimum of ten days, such as fluconazole, itraconazole or voriconazole.
-Laryngitis Caused by Aspergillus: The most common causal agents are Aspergillus fumigatus and Aspergillus flavus. Larynx can result affected due to sinusitis, lower respiratory tract disease or by hematogenous spread. The microorganism can cause tissue death. The treatment in this case consists in Amphotericin B.
-Laryngitis Caused by Histoplasma: Histoplasmosis is a mycotic systemic infection caused by Histoplasma capsulatum that can affect the larynx producing some painful tumorations. This condition can get worse with ulceration of the area compromising the airway. In the case of extrapulmonary or disseminated histoplasmosis the chosen treatment is Ketoconazole. In patients with a neurological disorder or AIDS intravenous Amphotericin B is a better option.
Granulomatous Laryngitis
-Tuberculous Laryngitis: Tuberculous laryngitis is the most frequent granulomatous disease of the larynx. It is generally produced by bronchogenic spread through the infected sputum that causes direct contamination of the laryngeal mucosa. Standard medical treatment consists of Rifampicin, Isoniazide and Pyrazinamide. In most cases there is a favorable response to drug treatment.
-Syphilitic Laryngitis: Syphilis is caused by T. pallidum, it can affect the larynx in advanced stages. In secondary syphilis, the larynx may have diffuse erythematous papules, edema, ulcers that mimic carcinoma, and cervical adenopathies (large or swollen lymph nodes). They can resolve spontaneously in several weeks. The axis of the treatment is penicillin.
Conclusion
As it was mentioned, chosen treatment will vary according to the causal microorganism. The use of antibiotics in acute laryngitis is questionable, restricting it when bacterial infections are suspected. The antibiotic therapy is empirical implicating the use of second and third generation cephalosporins that protect against H. influenzae B or macrolides. However, conservative measures must not be forgotten.
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