Laryngitis: When You Lose Your Voice

How laryngitis affects your voice

The larynx sits at the top of the windpipe. It contains two vocal cords (vocal folds) that vibrate as air passes between them to make sound. When the cords are inflamed and swollen, they cannot vibrate smoothly or close properly. The voice becomes:

• hoarse, rough or raspy
• weak or breathy
• lower in pitch
• reduced to a whisper, or gone

Symptoms

• hoarseness or voice loss
• a dry, tickly or sore throat
• dry cough and constant throat clearing
• a feeling of something in the throat
• symptoms of a cold or flu: runny nose, fever, aches
• in young children, laryngitis can cause croup with a barking cough and noisy breathing

Acute vs chronic laryngitis

Acute causes

• viral infections: colds, flu, COVID-19
• voice strain: shouting at games, singing, prolonged speaking
• irritants: smoke, fumes, alcohol binges
• bacterial infections: uncommon
• rarely, diphtheria in unvaccinated people

Chronic causes

• acid reflux: stomach contents reaching the throat, often without heartburn (laryngopharyngeal reflux); causes morning hoarseness, throat clearing and a lump-in-throat feeling
• smoking and vaping
• chronic voice misuse in teachers, singers, coaches and call-center workers, which can lead to vocal cord nodules, polyps or cysts
• inhaled corticosteroids for asthma, which can irritate the cords or cause thrush; rinse after each use
• allergies and post-nasal drip
• chronic sinusitis
• excess alcohol

Other causes of hoarseness to rule out

Persistent hoarseness is not always laryngitis. Doctors also consider:

• vocal cord paralysis after surgery, from nerve damage or tumors
• benign growths (polyps, cysts, papillomas)
• laryngeal cancer, especially in smokers and heavy drinkers
• neurological conditions such as Parkinson's disease
• hypothyroidism

Diagnosis

Acute laryngitis is diagnosed from symptoms. For hoarseness lasting more than 3 to 4 weeks, or with red flags, an ENT specialist looks directly at the vocal cords with laryngoscopy: a thin flexible camera passed through the nose, done in the office in a few minutes. Stroboscopy shows how the cords vibrate. Biopsy is done if a growth is seen.

Treatment

Self-care (acute laryngitis)

• rest your voice: speak as little as possible; avoid shouting
• do not whisper: it can strain the cords more than soft speech
• drink plenty of fluids to keep the cords moist
• humidify the air or breathe steam
• avoid smoke, alcohol and caffeine
• soothe the throat: honey in warm drinks (not for babies under 12 months), lozenges for adults and older children
• pain relief: acetaminophen (paracetamol) or ibuprofen for throat pain or fever, following the label dose
• avoid decongestants, which can dry the throat

Antibiotics do not help viral laryngitis. Steroids are occasionally used for professional voice users in urgent situations, under specialist advice.

Chronic laryngitis

• treat reflux: avoid late meals, raise the head of the bed, cut down on alcohol, caffeine and fatty foods; medicines if needed
• stop smoking
• voice therapy with a speech-language pathologist to improve voice technique
• rinse and gargle after inhaled steroids; use a spacer
• treat allergies and sinus problems

Prevention

• stay hydrated, especially if you use your voice a lot
• use a microphone for teaching or presentations
• avoid smoking and secondhand smoke
• manage reflux
• wash hands to reduce colds

Frequently asked questions

How long does laryngitis last?

Acute laryngitis from a cold or voice strain usually improves within 3 to 7 days and is gone within 2 weeks. Hoarseness lasting more than 3 to 4 weeks is considered chronic and should be checked by a doctor.

Is laryngitis contagious?

The laryngitis itself is not contagious, but the virus causing it often is, especially in the first few days of a cold or flu. Laryngitis from voice strain, reflux or smoking is not contagious.

What is the fastest way to cure laryngitis?

Rest your voice, drink plenty of fluids, breathe humidified air and avoid smoke and alcohol. Speak softly rather than whispering. Most acute laryngitis improves within days. There is no medicine that instantly restores the voice.

Should I whisper if I have laryngitis?

No. Whispering can strain the vocal cords as much as or more than normal speech. It is better to rest your voice completely or speak softly in a relaxed way when you must talk.

When should I see a doctor for hoarseness?

See a doctor if hoarseness lasts more than 3 to 4 weeks, especially if you smoke, or if you have trouble breathing or swallowing, cough up blood, have a neck lump or ear pain, or lost your voice after surgery or injury.