Laryngopharyngitis

Disease Description (Causes and Symptoms)

• Definition and pathophysiology: Laryngopharyngitis is an inflammatory reaction occurring in the mucous membranes of the upper respiratory tract that cover the pharynx and larynx, including the vocal cords. It usually begins with a viral infection, while repeated irritation, gastroesophageal reflux, smoking, alcohol consumption, and excessive use of the vocal cords can cause it to become chronic or worsen symptoms. Mucosal congestion, swelling, and increased secretions caused by inflammation can lead to pain, coughing, and changes in the voice.
• Main causes: Viruses (cold-causing viruses) > bacteria, excessive use of the vocal cords (acute traumatic laryngitis), smoking, alcohol consumption, air pollution, gastric acid reflux (reflux laryngopharyngitis), and psychological tension (functional symptoms).
• Main symptoms: Throat pain (sore throat), painful swallowing (odynophagia), a foreign-body sensation in the throat (globus sensation), hoarseness (voice changes), dry or phlegmy cough, and postnasal drip. When the cause is reflux-related, hypertrophy of the laryngeal mucosa and contact ulcers may be observed.

Treatment Methods

• General principles: Identify and treat the cause while relieving symptoms. Most cases improve with conservative treatment.
• Medication treatment
  • Symptomatic treatment: Relieve pain with analgesic anti-inflammatory drugs (e.g., NSAIDs).
  • Antibiotics: Use only when a bacterial infection is strongly suspected or confirmed (antibiotics are generally unnecessary for viral infections).
  • Short-term oral steroids: Short-term administration may be considered in cases of laryngeal swelling or severe voice impairment (at the physician’s discretion).
  • When reflux laryngopharyngitis is present: Acid-suppressing medication (PPI) and lifestyle modification.
• Non-drug treatment and self-care
  • Get sufficient rest and drink plenty of fluids, maintain indoor humidity (use a humidifier), and gargle with lukewarm salt water.
  • Avoid excessive use of the voice (voice rest) and avoid irritating foods and beverages (spicy foods, alcohol, and tobacco).
• Additional treatment
  • If the condition becomes chronic or voice problems persist, a laryngoscopic examination (laryngoscopy) by an otolaryngologist and voice therapy (speech therapy and vocal-cord rehabilitation) are recommended.
  • In emergencies such as airway obstruction (shortness of breath or marked wheezing) or bleeding, immediate emergency treatment and hospitalization are required.
• Complications and prognosis
  • Most people recover after the acute phase, but repeated inflammation can progress to chronic laryngitis, vocal-cord nodules or structural changes, contact ulcers, and, rarely, airway obstruction.
  • In high-risk groups (long-term smokers or alcohol users and older adults), persistent hoarseness lasting more than 2 weeks requires additional testing (laryngoscopy and biopsy).

Checklist Before an Outpatient Visit (Including Example Questions)

• Items and documents to prepare
  • A list of medications currently being taken (including prescription drugs, over-the-counter drugs, herbal medicines, and supplements)
  • Previous test results (such as recent laryngoscopy or endoscopy images, chest X-ray results, and upper endoscopy results) and diagnostic records
  • When symptoms began and their course (how many days they have lasted), symptom patterns (whether they worsen during the day or at night), and the degree of voice change (e.g., whether it is nearly impossible to speak)
  • Record of accompanying symptoms: fever, shortness of breath, ear pain, weight loss, nighttime cough, and gastric reflux (heartburn or a sensation of reflux)
  • Lifestyle information: amount of smoking, alcohol consumption, occupational voice use (such as teaching or singing), and sleep and dietary patterns
• Precautions before an outpatient visit
  • Visit while refraining from smoking and alcohol as much as possible (to improve the accuracy of tests and diagnosis)
  • If symptoms are severe (shortness of breath, high fever, bloody sputum or bleeding, or severe difficulty swallowing), visiting an emergency room is recommended
• Example questions (questions patients can prepare themselves)
  • Bringing recent symptom photos or a recording (voice sample) can help with diagnosis.

Examples of General Questions to Ask the Doctor

• What are the expected effects and side effects of this medication (the prescribed medication)?
• Are antibiotics necessary, and if so, how long should they be taken?
• How long do symptoms need to persist before additional tests (laryngoscopy, endoscopy, or biopsy) are necessary?
• What lifestyle changes are essential (such as smoking, alcohol consumption, sleep, and meals)?
• What measures (e.g., voice therapy or treatment for acid reflux) are needed to prevent recurrence?

Examples of Disease-Specific Questions

• Gastroesophageal reflux (reflux laryngopharyngitis) is suspected. If reflux is the cause, which should take priority: medication (a proton pump inhibitor) or dietary and sleep habit changes?
• I use my voice extensively for work (such as teaching or singing). Do I need voice therapy (speech therapy) or vocal-cord rehabilitation, and when should I begin?