Like “indisposition,” the word “laryngitis” covers a multitude of conditions, from a bit of hoarseness to a raging throat infection. This is the first important point: Although “-itis” implies an inflammation, that inflammation may have many different causes, and may in fact not even be present! Hoarseness is the key feature of laryngitis for most singers. It can be caused by many other mechanisms, many of which cause no inflammation (such as a virally caused weakness of one vocal fold).
The commonest form of laryngitis presents after an upper respiratory infection. Typically, the infection begins in the nose and sinuses, and progresses down: postnasal drip, sore throat, and then hoarseness. The hoarseness may be mild, or lead to a complete loss of the voice. As the condition continues its inexorable descent, a tracheitis may be next, with a dry tickly cough, which progresses to bronchitis, and a full “chest cold”, with a productive cough.
For most singers, the greatest distress in all of this comes from the loss of voice. Succinctly put, loss of voice equals loss of income. Stricken with the double whammy of sore throat and no voice, one imagines that the vocal folds must look like red sausages, swollen and unable to move. The absence of voice continues for several days, with only the occasional squeak produced by superhuman effort. After days of senza voce, the sound gradually returns, although it may take up to a week before singing is close to normal again.
One of the most surprising findings in examining the vocal folds with “laryngitis” is that they often look absolutely normal. More often than not, the larynx that is unable to produce any voice looks clean, the vocal folds white and mobile. So why can this larynx not sing, and not even speak? I believe the cause lies not in the larynx but the muscles of the pharynx and the neck. Irritation of these muscles pulls the larynx up in the neck, out of its usual phonating position. If these muscles contract (and contract they will, irritated by the inflamed mucous membranes that cover them), the larynx can be elevated so high that it is unable to phonate. The next time you have laryngitis, feel your neck, and check the position of your larynx to confirm this. Then, as the pharyngitis subsides, the muscles relax, and the larynx can be brought down into its normal voice-producing position.
The significance of the above is enormous. It means that, even if your laryngitis has left you temporarily with no voice, your vocal folds are “okay.” It is just a matter of treating the infection or waiting it out until your immune system defeats the invaders. Your voice should return, with absolutely no visible or audible change to the vocal folds. (Obviously, if the hoarseness persists for more than 2 weeks, you do need to have the larynx examined.)
So, the truth is that the most common form of “laryngitis” is not laryngitis at all. There is no significant inflammation of the vocal folds, just a temporary “malpositioning” of the larynx.
What are the do’s and don’ts of hurrying “laryngitis” along? First, don’t bother gargling. While this may help your sore throat, it does not reach down any farther than the tonsils, and certainly not to the larynx. On the other hand, if you do have a sore throat, warm saline gargles or hot ginger tea can be very comforting.
Most importantly, do not force the voice, even to the level of a stage whisper. If you do, you may quickly acquire a harmful and excessively tense way of phonation, which may persist even after the voice returns. Avoid noisy places, since increased ambient noise subconsciously positions the larynx into a state of “speaking readiness,” further increasing muscle tension.
The best treatment is complete vocal silence, which in most cases should not last more than 3-5 days. If you want to medicate the laryngeal area, try either inhalers (such as steam from a vaporizer or nebulizer), or drinking hot drinks, which will help the pharyngeal muscles relax. Gentle massaging of the neck may further aid the descent of the voicebox to its normal phonating position. And before you know it, your “indisposition” will self-dispose!
DISCLAIMER: The suggestions given by Dr. Jahn in these columns are for general information only, and not to be construed as specific medical advice or advocating specific treatment, which should be obtained only following a visit and consultation with your own physician.
