Chronic laryngitis (CL) is chronic laryngeal inflammation with an annual incidence of about 4 cases per population of 1000 [1]. The most common cause of CL is laryngopharyngeal reflux but other causes include vocal abuse (singing, teaching), smoking, excessive alcohol and caffeine intake, bacterial and fungal infections as well as occupations like glass blowing [2] [3] [4].

Patients usually present with waxing and waning dysphonia, globus (foreign body) sensation in the throat, pain in the throat, constant urge to clear the throat, and dry cough. Symptoms of dysphonia include reduced volume, hoarseness, raw sensation, inability to modulate the voice and vocal fatigue.The symptoms depend on the severity of the inflammation. In severe infections, patients may have a fever, laryngeal edema, dyspnea and even stridor. Chronic laryngeal mucosal injury secondary to gastroduodenal reflux (GERD) of acidic contents has been implicated as a cause of CL in almost 50% of the patients [5]. Clinical features of CL associated with GERD are called laryngopharyngeal reflux (LPR) as the main region affected is the laryngopharynx [6] [7].

The diagnosis of CL is based on clinical evaluation and patient history. It is vital for the otolaryngologist to inquire about the patient's occupation, allergies, vocal abuse and infections (tuberculosis). During the physical examination, an indirect, as well as, flexible nasopharyngolaryngoscopy is performed in all patients presenting with dysphonia lasting longer than 3 weeks. LPR can be diagnosed on the basis of the presenting symptoms and the appearance of laryngeal edema and arytenoid erythema on laryngoscopy [8]. In addition, thick, sticky mucus may be noticed in the piriform sinuses and valleculae. A video-stroboscopy provides information about vocal fold anatomy, vibratory pattern and can help to differentiate between a sulcus vocalis from mucosal stiffness. If infective etiology is suspected then a complete blood cell count, erythrocyte sedimentation rate with sputum cultures and sensitivities for bacteria, fungi, and viruses should be ordered. Serology for autoimmune disorders like sarcoidosis should also be considered. Skin allergy testing is recommended if an allergic etiology is suspected. Barium swallow, manometry and 24 hour pH monitoring are recommended for the diagnosis of GERD.
Although plain X-ray neck has no role in the diagnosis of CL, plain X-ray chest may help to detect pulmonary tuberculosis or sarcoidosis as the cause of CL. Computed tomographic scan and magnetic resonance scan are not routinely performed but may help to detect soft tissue changes, structural laryngeal changes, as well as, tumors.
Microlaryngoscopy under general anesthesia to visualize the larynx with a microscope may be necessary to detect tiny lesions and obtain tissue for biopsy, as well as for staining and cultures. The histological examination may reveal pachydermia (in long-term smoker's CL), amyloidosis, granulomatous lesions as well as malignancies. Lipoid proteinosis with hyaline deposits can mimic chronic laryngitis [9] on histology.

Treatment for chronic laryngitis focuses on addressing the underlying cause and relieving symptoms. Common approaches include:

• Voice rest: Reducing vocal strain by limiting speaking and avoiding whispering.
• Hydration: Drinking plenty of fluids to keep the throat moist.
• Medications: Using anti-inflammatory drugs or corticosteroids to reduce inflammation.
• Avoiding irritants: Steering clear of smoking, alcohol, and other irritants.
• Speech therapy: Working with a speech therapist to improve vocal techniques.

The prognosis for chronic laryngitis largely depends on the underlying cause and adherence to treatment. With appropriate management, many patients experience significant improvement in symptoms. However, if left untreated, chronic laryngitis can lead to persistent voice problems and, in rare cases, complications like vocal cord damage.

Chronic laryngitis can result from various factors, including:

• Vocal strain: Overuse or misuse of the voice.
• Irritants: Exposure to smoke, pollution, or chemicals.
• Infections: Persistent viral or bacterial infections.
• Gastroesophageal reflux disease (GERD): Stomach acid irritating the larynx.
• Allergies: Allergic reactions causing throat inflammation.

Chronic laryngitis affects individuals of all ages but is more common in adults, particularly those who use their voice professionally, such as singers, teachers, and public speakers. Environmental factors, such as exposure to pollutants and smoking, also contribute to its prevalence.

The pathophysiology of chronic laryngitis involves prolonged inflammation of the laryngeal tissues. This inflammation can lead to changes in the vocal cords, such as thickening or nodules, which affect voice quality. Persistent irritation from factors like acid reflux or allergens exacerbates the condition, perpetuating the cycle of inflammation.

Preventing chronic laryngitis involves lifestyle modifications and avoiding known triggers. Key preventive measures include:

• Avoiding smoking and secondhand smoke: Smoking is a major irritant to the larynx.
• Managing acid reflux: Following dietary recommendations and medications to control GERD.
• Using proper vocal techniques: Learning to use the voice efficiently to prevent strain.
• Staying hydrated: Drinking water regularly to keep the throat moist.

Chronic laryngitis is a persistent inflammation of the larynx that can significantly impact voice quality and comfort. Understanding its causes, symptoms, and treatment options is essential for effective management. With appropriate care, most patients can achieve symptom relief and prevent further complications.

If you suspect you have chronic laryngitis, it's important to monitor your symptoms and consider potential triggers. Simple lifestyle changes, such as staying hydrated and avoiding irritants, can make a significant difference. If symptoms persist, consult a healthcare professional for a thorough evaluation and personalized treatment plan.

1. Stein DJ, Noordzij JP. Incidence of chronic laryngitis. Ann Otol Rhinol Laryngol. 2013;122:771-774.
2. Baletic N, Jakovljevic B, Marmut Z, Petrovic Z, Paunovic K. Chronic laryngitis in glassblowers. Ind Health. 2005;43:302-307.
3. Chen H, Thornley P. Laryngeal tuberculosis: a case of a non-healing laryngeal lesion. Australas Med J. 2012;5:175-177.
4. Allen CT, Merati AL. Acute and chronic laryngitis; in Flint PW, Haughey BH, Lund VJ, Niparko JK, Robbins KT, Thomas JR, Lesperance MM (eds). Cummings Otolaryngology Head & Neck Surgery. Philadelphia, Mosby Elsevier, 2015, pp 928-935.
5. Koufman JA. The otolaryngologic manifestations of gastroesophageal reflux disease (GERD): a clinical investigation of 225 patients using ambulatory 24-hour pH monitoring and an experimental investigation of the role of acid and pepsin in the development of laryngeal injury. Laryngoscope. 1991;101:1-78.
6. Koufman JA. Laryngopharyngeal reflux is different from classic gastroesophageal reflux disease. Ear Nose Throat J. 2002;81:7-9.
7. Koufman JA, Aviv JE, Casiano RR, Shaw GY. Laryngopharyngeal reflux: position statement of the Committee on Speech, Voice, and Swallowing Disorders of the American Academy of Otolaryngology-Head and Neck Surgery. Otolaryngol Head neck Surg. 2002 Jul;127 910: 32- 5
8. Farrokhi F, Vaezi MF. Laryngeal disorders in patients with gastroesophageal reflux disease. Minerva Gastroenterol Dietol. 2007;53:181-187.
9. Oz F, Kalekoglu N, Karakullukçu B, Oztürk O, Oz B. Lipoid proteinosis of the larynx. J Laryngol Otol. 2002 Sep; 116(9):736-9