November 13, 2023

Reflux Laryngitis



  • The terms laryngitis, hoarseness, and dysphonia are often used as synonyms, with dysphonia (abnormal phonation/vocalization) being the medical term; however, the term laryngitis specifically implies inflammation.
  • The most common cause of acute-onset laryngitis is an upper respiratory infection, and the most common cause of chronic laryngitis is respiratory reflux.
  • Reflux is reflux is #1 cause of laryngitis, affecting about 85% of people with voice disorders. In addition, chronic laryngitis often has several causal factors, e.g., reflux, vocal abuse, smoking, and drinking.

Note: Respiratory Reflux (RR) and Laryngopharyngeal Reflux (LPR) are synonyms and the terms can be used interchangeably. Going forward, I prefer the term RR and so should you; it is easier to pronounce, more intuitive, more comprehensive, and implies that RR can affect any and all parts of the respiratory system, which it does.

The term laryngitis is misused by both lay and medical people; its literal definition is inflammation of the larynx (voice box). Nevertheless, “laryngitis” is used as a synonym for hoarseness. And the most common cause of laryngitis is acid reflux, specifically respiratory reflux (aka LPR). Other less common causes are viral throat infections, vocal abuse/misuse syndromes, and growths on the vocal cord(s).  

Viral Laryngitis

Viral laryngitis is easy to diagnose, because it is associated with an upper respiratory infection (URI). Other URI symptoms are also usually present, such as sore throat, cough, low-grade fever, etc. URIs can cause so much vocal cord inflammation and swelling that the sufferer may be voiceless … have no voice at all. That said, the person had a normal voice before the virus, and should have a normal voice after. There is no effective medial treatment for viral laryngitis. It will run its course in 5 to 7 days, and antibiotic treatment is not helpful.

Vocal Abuse/Misuse Syndromes

If one screams loud and long enough, the vocal cords get beaten up. Indeed, they get so stiff and swollen that the voice can be severely compromised. This problem usually occurs when a person has to constantly yell over loud ambient noise. This is most commonly seen in athletic coaches who have to communicate with far-away players … and over crowd noise. I have seen this most in football and basketball coaches. This group can develop secondary vocal cord nodules and polyps that may compound the voice problem. and extend it beyond the athletic season.

Vocal Cord Growths

The most common vocal cord growths are nodules and polyps; far less common are hemorrhages, papillomas, and cancers. Most people with nodules and polyps have reflux laryngitis. The most extreme vocal cord polyps, so-called Reinke’s edema are caused by reflux … and also rarely by hypothyroidism.

Reflux Laryngitis

Reflux laryngitis is ubiquitous; and it is an important factor is about 85% of people voice disorders. And reflux laryngitis comes in different sizes; that is, there is variation in its presentation and impact. Hoarseness associated with reflux can be intermittent or chronic, but most people with reflux laryngitis hardly ever have flat-normal voices.

“Whiskey voice“ is a term that describes awakening in the morning with a very hoarse and raspy voice and a pitch that is lower than normal. “Whiskey voice” is so-called because it is often seen in people who go out drinking the night before. Having refluxed all night on the vocal cords, they are very very swollen … hence the bad voice. The type of person who gets whiskey voice almost always has some degree of chronic reflux as well.

Chronic reflux laryngitis is usually associated with some lowering of the pitch of the voice, contraction of the pitch range, raspiness, vocal fatigue, and effortful speaking. Again, chronic reflux can cause of worsen all types vocal cord pathology. BTW, with reflux laryngitis the laryngeal examination always shows bilateral (both–sided) swollen vocal cords … at the least.

Even if it is not the main cause, respiratory reflux can worsen any and all other voice problems, For example, in patients with virus-induced laryngeal papillomas ― the proper name is RRP, recurrent respiratory papillomaswe have previously reported that RRP patients with uncontrolled reflux are far more likely to develop permanent post-operative scarring than patients that are reflux controlled.

In conclusion, when it comes to the voice, reflux laryngitis is ubiquitous, and it is an important factor is most people voice disorders. By the way, with reflux laryngitis, voice therapy and training will never really correct the underlying problem.

The treatment of reflux laryngitis is covered elsewhere in this blog; see Why a Low-Acid Diet for Acid Reflux?Silent RefluxI’m Pregnant and Have Terrible Heartburn and Acid Reflux, What Can I Do? … and … Is a Vegan or Vegetarian Diet Good for Acid Reflux?  

For more information about diagnosis and treatment of reflux laryngitis, see my two companion books on Amazon: Dropping Acid: The Reflux Diet Cookbook & Cure and Dr. Koufman’s Acid Reflux Diet. And, if you would like to schedule a virtual consultation with me, you can book it online.

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