What causes loss of voice and sore throat

Laryngitis is the inflammation of the larynx (voice box) which is located in your throat. Symptoms include hoarseness and loss of voice. Treatment mainly involves not talking, avoiding irritants, and breathing moist air from a humidifier or hot water.

Most cases of laryngitis get better within a week or two. Laryngitis that lasts more than three weeks can indicate a serious underlying medical condition.

General information

The larynx is part of the upper respiratory tract (upper airway) that connects your mouth with your lungs. It contains your vocal cords, which you use to talk and sing. When the vocal cords become irritated or inflamed, they swell up, which distorts the sounds they produce. This results in the voice sounding hoarse or croaky and in some cases may barely be heard.

Causes

Laryngitis can be caused by many things, but most commonly involves an infection or injury to the larynx. The causes of acute (short-term) and chronic (longer lasting) laryngitis differ.

Acute laryngitis

Most cases of laryngitis get better over the course of a week or two as the underlying cause resolves, or is removed or minimised. Causes of acute laryngitis include:

Viral respiratory infections, such as a common cold or flu

Vocal strain or injury caused by shouting or talking or singing loudly, or for long periods

Persistent clearing of the throat or prolonged coughing

Bacterial or fungal infection.

Chronic laryngitis

Laryngitis that lasts longer than three weeks is considered to be chronic laryngitis. It is generally caused by exposure to irritants over time. Chronic laryngitis can result in vocal cord strain and injury or the growth of polyps or nodules on the vocal cords. Causes of chronic laryngitis include:

• Heart burn (acid reflux) or gastroesophageal reflux disease (GERD), in which the back-flow of stomach acid upwards into the oesophagus may reach the throat and irritate the vocal cords
• Constant overuse of the voice, e.g. singers
• Chronic sinusitis
• Inhaled irritants, e.g. chemical fumes, allergens, smoke
• Excessive alcohol consumption
• Smoking.

Signs and symptoms

Symptoms usually appear suddenly and gradually worsen over two to three days. The duration of most cases of laryngitis is less than two weeks and probably won't require a visit to your GP. Common signs and symptoms of laryngitis include:

• Hoarseness or croakiness
• Faint voice or voice loss
• Dry throat
• Throat feels scratchy or raw
• Dry irritating cough
• Sore throat
• Constant urge to clear the throat.

If laryngitis is associated with another illness, such as a cold, flu, throat infection (pharyngitis) or tonsillitis, the following symptoms may also be present:

• Headache
• Fever
• Swollen glands
• Runny nose
• Pain when swallowing
• Tiredness
• Aches and pains.

When to see a doctor?

You should go to an emergency room for urgent medical assessment if a child’s laryngitis is accompanied by:

• Difficulty breathing or swallowing
• High-pitched wheezing when breathing (stridor)
• Drooling.

You should see your GP if you have one or more of these symptoms:

• Fever over 38⁰c
• Ear pain
• History of immunodeficiency
• Recent unintentional weight loss
• History of smoking
• Current or recent radiotherapy in the neck region
• Recent neck surgery or anaesthesia that involved endotracheal tubing
• Laryngitis symptoms over three weeks (chronic laryngitis).

Diagnosis

Your GP will likely ask you about possible causes of your laryngitis including overusing your voice, smoking and alcohol intake, and allergies. They may also examine your larynx using a mirror to look for redness or swelling and may take blood and a throat swab to test for possible infection of your upper airways.

You might be referred to an ear, nose, and throat (ENT) specialist for additional tests, which could include:

• Laryngoscopy: This is a procedure that involves inserting a thin, flexible tube with a tiny camera and light at the end (endoscope) through your nose or mouth and into the back of your throat. This enables close visual examination of the larynx and for the specialist to observe the movement of your vocal cords as you speak
• Biopsy: If a suspicious area is seen with the laryngoscopy, a sample of tissue (biopsy) may be taken for examination under a microscope to check for throat cancer. Alcohol and tobacco are the two primary risk factors for developing throat cancer.

Treatment

Most cases of laryngitis get better within a week or two without the need for medical treatment.

Self-care

The following self-care steps and home treatments may relieve the symptoms of laryngitis, reduce the strain on your voice, and help the vocal cords to heal:

• Avoid talking and rest your voice as much as possible. If you have to talk, speak softly rather than whisper. Whispering strains your vocal cords more than normal speech
• Breathe moist air – use a humidifier to moisten the air in the home or office and/or inhale steam from a bowl of hot water or a hot shower
• Drink plenty of water to prevent dehydration (and avoid alcohol and caffeinated beverages)
• Keep your throat moist by sucking on lozenges, chewing gum, or gargling with warm slightly salty water
• Quit smoking and avoid smoky, dry, or dusty environments
• Do not use decongestants because they can dry out your throat.

Medical treatment

It may be possible to treat the underlying cause of laryngitis by using:

• Antibiotics to treat bacterial infections, although in most cases of laryngitis the cause is a viral infection for which antibiotics are ineffective
• Medications that reduce the amount of stomach acid, which may help to reduce heartburn and GERD
• Antihistamines (and avoiding known allergens) if an allergy is causing your laryngitis
• Corticosteroids to reduce vocal cord inflammation. They are only used when there is an urgent need to use your voice, e.g. giving an important presentation, speech, or singing recital
• Vocal therapy, if you have laryngitis due to habitually straining your voice.

Prevention

The risk of developing laryngitis can be reduced by:

• Drinking plenty of water. Staying hydrated helps keep the mucus in your throat thin and easy to clear
• Avoiding upper respiratory tract infections. Get an annual flu vaccination, wash your hands regularly, avoid close contact with people who have a cold or flu
• Avoiding inhalation of environmental irritants (e.g. smoke or dust), especially if you have an upper respiratory tract infection
• Not smoking and avoiding second-hand tobacco smoke
• Not drinking alcohol excessively
• Avoiding shouting or singing loudly or for prolonged periods of time. People who regularly use their voice should receive training from a voice coach to prevent injuring their larynx
• Avoiding regularly clearing your throat. This can irritate the larynx and increase swelling of the vocal cords
• Raising your head with pillows or raising the head-end of your bed. If you have heartburn or GERD, this may help to prevent stomach acid from reaching the larynx when you lie down or sleep
• Avoiding foods that cause heartburn or GERD: coffee, alcohol, chocolate and spicy, fatty and acidic foods.

References

Mayo Clinic (2018). Laryngitis (Web Page). Rochester, NY: Mayo Foundation for Medical Education and Research. https://www.mayoclinic.org/diseases-conditions/laryngitis/symptoms-causes/syc-20374262 [Accessed: 20/03/19]
NHS inform (2019). Laryngitis (Web Page). Glasgow: National Health Information Service, National Health Service (NHS) Scotland. https://www.nhsinform.scot/illnesses-and-conditions/ears-nose-and-throat/laryngitis [19/03/19]
O’Toole, M.T. (Ed.) (2017). Larynx. Mosby’s Dictionary of Medicine, Nursing & Health Professions (10th ed.). St Louis, MI: Elsevier.
O’Toole, M.T. (Ed.) (2017). Laryngitis. Mosby’s Dictionary of Medicine, Nursing & Health Professions (10th ed.). St Louis, MI: Elsevier.

Created: April 2019

Go to our Medical Library Index Page to find information on other medical conditions.

The purpose of the Southern Cross Medical Library is to provide information of a general nature to help you better understand certain medical conditions. Always seek specific medical advice for treatment appropriate to you. This information is not intended to relate specifically to insurance or healthcare services provided by Southern Cross.

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