DEAR DOCTOR K: What could be causing my chronic laryngitis? And what can I do about it?
DEAR READER: Laryngitis is an inflammation of the larynx the "voice box" that contains the vocal cords. The condition is called chronic laryngitis when hoarseness, the most common symptom, lasts for at least two weeks.
Chronic laryngitis isn't caused by infection. Among adults, the most common causes of chronic laryngitis are:
- Voice abuse or misuse: Talking too much or too loudly.
- Drinking alcohol heavily.
- Gastroesophageal reflux disease (GERD): Stomach acids flow backward (reflux) into the esophagus and throat, irritating the vocal cords.
- Work-related exposure to chemicals or dusts that irritate the vocal cords.
To figure out what's causing your chronic laryngitis, your doctor will review your symptoms. Then he or she will ask about the risk factors above.
Your doctor will ask for a list of all medications you take. Some medications, including antihistamines and cough suppressants, can cause hoarseness.
Your doctor will examine your mouth, throat, nose, ears and the lymph nodes in your neck. He or she will carefully examine your larynx. Additional tests may check for acid reflux.
Hoarseness that doesn't go away or keeps coming back can be a symptom of certain cancers. Cancer of the vocal cords can occur. Also, sometimes an enlarging lung cancer can pinch the nerve that controls the muscles of the vocal cords.
When my patients have a hoarseness that persists, I send them to an ear, nose and throat specialist. That specialist has special equipment that lets him see the vocal cords directly. Cancer still is quite unusual. More often, the specialist sees that the vocal cords have been irritated by cigarette smoke, stomach acid or something in the air the person breathes.
No matter the cause, always stay well hydrated to help keep your vocal cords moist. And use a humidifier at home.
If your chronic laryngitis is due to irritation, then it will improve if you reduce your exposure to whatever substance is affecting your vocal cords.
If your condition is due to voice overuse, avoid long bouts of shouting or uninterrupted talking. Also consider voice therapy, which teaches you to speak in ways that won't injure your vocal cords.
I have a patient who is a teacher and gives an intensive course every day during the spring. One year he developed chronic laryngitis shortly after starting the course and struggled to get through the rest of it. He took voice therapy, and the next year he sailed through the course without any voice trouble.
If GERD is the culprit, ask your doctor about strategies to control your reflux and reduce your stomach acid.
Though hoarseness may seem like a minor inconvenience, it's important to avoid the factors that irritate your larynx. If you don't, you may develop small nodules or polyps on your vocal cords that can cause permanent hoarseness and may need to be surgically removed. That surgery is typically quite successful.
Dr.Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.
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