Laryngeal pain: laryngitis or another cause?

What is the larynx? 

The larynx connects the pharynx to the windpipe and fulfils two very important bodily functions. On the one hand, it closes the windpipe when swallowing so that no food can slip in. On the other hand, the vocal folds (also known as vocal cords), which are located roughly in the centre of the larynx, ensure that our voice can be heard at all. They close when we inhale and vibrate when we exhale, generating sound waves. While the framework of the larynx consists of cartilage, the inside is covered with mucous membrane. In men in particular, the larynx is often clearly visible from the outside as the Adam's apple.

Pain in the larynx due to laryngitis

Similar to gum inflammation or inflammation of the oral mucosa , the mucous membrane of the larynx can also become inflamed (technical term: laryngitis). The result: pain in the larynx - especially when swallowing - and hoarseness. The fact is that if the vocal folds become mucoused or swollen (or even scarred in the case of chronic inflammation) due to inflammation, they can no longer vibrate properly. This makes our voice sound deeper than usual and hoarse. The more tense the vocal cords are, the higher the pitch they produce. 

Laryngitis can occur at any age. Doctors distinguish between acute laryngitis and chronic laryngitis. Acute inflammation is often caused by a viral infection of the upper respiratory tract - for example a cold, flu or coronavirus. The inflammation then descends to the larynx and often occurs in combination with pharyngitis. The pain in the larynx then automatically disappears again as soon as the underlying illness has healed. In addition to viruses, bacteria can also be involved in acute laryngitis. Anyone who talks a lot and loudly favours the development of laryngitis. 

Causes of chronic laryngitis

Chronic laryngitis is when the inflammation lasts for several weeks. Causes include:

• Smoking
• Alcohol consumption
• Frequent severe strain on the voice due to loud speaking or singing (especially with the wrong technique)
• Unfavourable environmental influences (e.g. inhalation of dust or harmful substances at the workplace)
• Heartburn (irritation of the mucous membrane of the larynx due to stomach acid)
• Use of asthma spray with cortisone
• Benign tumours
• Mouth breathing (e.g. chronic rhinitis due to allergies or chronic sinusitis)

Symptoms of laryngitis

The main symptom of laryngitis is hoarseness, which can range from a slight croak to complete loss of voice. The following symptoms may also occur:

• Pain in the larynx 
• Rough, dry cough
• Breathing difficulties 
• Possibly fever
• Foreign body sensation ("lump in the throat")
• Compulsive throat clearing due to dry throat

As acute laryngitis is usually associated with viral infections of the respiratory tract, typical cold symptoms such as cough, runny nose and sore throat are also common.

Where do you have pain with laryngitis?

Laryngitis causes pain in the larynx (especially when swallowing), which can be quite severe. Speaking can also cause pain. 

Progression of laryngitis

Acute laryngitis usually subsides within a few days if the affected person rests their voice. If bacteria are involved in the inflammation, your doctor may prescribe antibiotics. In the case of chronic laryngitis, the cause of the permanent irritation of the laryngeal mucosa must first be identified and eliminated. If hoarseness and pain in the larynx persist for longer than three weeks, you should definitely consult an ENT specialist and have a check-up.

Laryngitis in children

Acute laryngitis can be very dangerous in young children, especially infants. A sudden, severe swelling of the laryngeal opening, which usually occurs at night, can trigger a severe coughing fit with hoarseness and "whistling" breathing. In such cases, doctors speak of "pseudo-croup" or "croupy cough". It is important to calm the child, as excitement worsens the symptoms and can trigger an attack of suffocation. The coughing fit usually subsides with fresh air or by humidifying the air. It is best to take the child into the bathroom, turn on the taps and open the windows. In the event of severe breathing difficulties, please call an ambulance immediately! 

Another form of laryngitis that mainly occurs in children is epiglottitis. This disease is now very rare in Germany as there are immunisations for children. In this bacterial inflammation, the epiglottis at the entrance to the larynx swells considerably and causes pain in the larynx when swallowing, which can be very severe. Affected children usually have a high temperature, speak "clunkily" and have difficulty swallowing their saliva due to the severe pain, causing it to run out of their mouth. The severe swelling of the epiglottis can lead to shortness of breath and choking. The same applies here: call an ambulance immediately in the event of severe breathing difficulties! Epiglottitis is treated with antibiotics, which leads to rapid healing. 

Other possible causes of laryngeal pain

If you complain of pain at, below or above the larynx or even unilateral pain on the right or left side of the larynx, it is not necessarily laryngitis. Of course, the same applies in all cases: If the pain lasts longer than two to three weeks or is very severe, you should definitely have yourself checked by a doctor!

Pain in the larynx due to thyroiditis

If the laryngeal pain does not come from the inside and mainly occurs when swallowing, but instead occurs when touched from the outside, the thyroid gland may be inflamed. Those affected feel seriously ill and have severe pain in the area of the larynx, which can radiate to the entire head and shoulder area - for example the throat, ears and tonsils. This is why thyroiditis is often mistaken for a cold or coronavirus infection. Unlike these infectious diseases, thyroid inflammation does not go away on its own. If this is the case, you should ideally be examined by an endocrinologist. Of course, you can also go to your GP first, who can refer you to a thyroid specialist if your suspicions are confirmed.

Laryngeal pain after gastroscopy

During a gastroscopy, a flexible videogastroscope is inserted through the mouth or nose to examine the larynx, pharynx, oesophagus, stomach and duodenum. Injuries are very rare. However, some patients experience a slight feeling of pressure on the larynx after a gastroscopy or complain of a slight pain in the larynx when swallowing. However, these symptoms usually pass very quickly.

Pain in the larynx due to stress

The feeling of having a "lump in the throat", which can also lead to laryngeal pain when swallowing as well as breathing difficulties and slight hoarseness, sometimes has psychological causes. People who are under psychological stress often experience tension in the muscles of the larynx, which can cause the "lump in the throat" feeling. Those affected often have strong fears - especially of cancer. Patients can be relieved of this fear through appropriate examinations by an ENT specialist.

Laryngeal pain after sneezing

If you are one of those people who suppress a sneeze out of politeness by keeping your mouth closed and pinching your nostrils together, this is the sign to stop. A sneeze should be let out freely. The forces generated by a sneeze are enormous and can even reach hurricane force. If you then keep the sneeze trapped in your body, it can cause damage, which can manifest itself in pain in the larynx, for example. This mainly leads to tension, overstretching and irritation. Cracks in the throat area are very rare, but can occur in extreme cases. 

Laryngeal pain after vomiting

You already know that heartburn can be a cause of chronic laryngitis because the mucous membrane is irritated by stomach acid. Gastric acid also enters the larynx during vomiting and can lead to irritation. Those affected then complain of a strong burning sensation in the throat area and difficulty swallowing. Pregnant women in particular, who have to vomit frequently, experience pain after retching and vomiting due to the constant irritation of the larynx. 

Laryngeal pain after gastroscopy

During a gastroscopy, a flexible videogastroscope is inserted through the mouth or nose to examine the larynx, pharynx, oesophagus, stomach and duodenum. Injuries are very rare. However, some patients experience a slight feeling of pressure on the larynx after a gastroscopy or complain of a slight pain in the larynx when swallowing. However, these symptoms usually pass very quickly.

Pain in the larynx due to stress

The feeling of having a "lump in the throat", which can also lead to laryngeal pain when swallowing as well as breathing difficulties and slight hoarseness, sometimes has psychological causes. People who are under psychological stress often experience tension in the muscles of the larynx, which can cause the "lump in the throat" feeling. Those affected often have strong fears - especially of cancer. Patients can be relieved of this fear through appropriate examinations by an ENT specialist.

Laryngeal pain after sneezing

If you are one of those people who suppress a sneeze out of politeness by keeping your mouth closed and pinching your nostrils together, this is the sign to stop. A sneeze should be let out freely. The forces generated by a sneeze are enormous and can even reach hurricane force. If you then keep the sneeze trapped in your body, it can cause damage, which can manifest itself in pain in the larynx, for example. This mainly leads to tension, overstretching and irritation. Cracks in the throat area are very rare, but can occur in extreme cases. 

Laryngeal pain after vomiting

You already know that heartburn can be a cause of chronic laryngitis because the mucous membrane is irritated by stomach acid. Gastric acid also enters the larynx during vomiting and can lead to irritation. Those affected then complain of a strong burning sensation in the throat area and difficulty swallowing. Pregnant women in particular, who have to vomit frequently, experience pain after retching and vomiting due to the constant irritation of the larynx. 

Reinke oedema

In Reinke's oedema, a gelatinous fluid is deposited in the vocal folds. Those affected complain of a particularly deep voice and hoarseness and have pain in the larynx when swallowing. The voice fails quickly and is no longer resilient. Reinke's oedema does not heal on its own, but must be surgically removed. It is particularly common in smokers and people who frequently put a lot of strain on their voice. It occurs more frequently in women than in men. They are often mistaken for a man on the phone as the oedema makes their voice sound much deeper.

Pain in the larynx: a sign of laryngeal cancer?

Can laryngeal pain be a sign of laryngeal cancer? Unfortunately, yes. Therefore, if you have persistent hoarseness or difficulty swallowing, you should see an ENT specialist after three weeks at the latest to have a check-up as a precautionary measure to rule out cancer. The first signs of laryngeal cancer hardly differ from those of normal laryngitis. Depending on the area affected, laryngeal cancer can manifest itself as follows:

First signs of tumours in the area of the vocal folds:

• Permanent hoarseness
• Rough voice
• Constant throat scratching and the need to clear your throat
• Chronic cough

As the disease progresses, breathing difficulties, shortness of breath and earache may also occur.

First signs of tumours above the vocal folds:

• Pain in the larynx when swallowing
• Swallowing disorders without a recognisable cause
• Foreign body sensation
• Pain that radiates into the ears

With this type of cancer, hoarseness only becomes apparent at an advanced stage. If metastases have already formed in the cervical lymph nodes, these can be recognised by lumps.

As the chance of recovery from laryngeal cancer is higher if the tumour is detected early, you should not put off seeing an ENT doctor if you have complaints in the larynx and should make an appointment as soon as possible.

Diagnosis: Which doctor is the right one for laryngeal pain? 

The right place to go for pain in the larynx is an ENT practice. Of course, you can also go to your family doctor first and be referred to an ENT specialist if necessary. 

To examine the larynx, the doctor inserts a laryngoscope through the mouth. This is a small hand-held device with a mirror on which the doctor can examine the larynx and vocal cords. A special laryngoscope, which can be inserted through the nose, is used for children and adults with a strong gag reflex. In the case of laryngitis, both the mucous membrane and vocal folds are reddened and swollen. In the case of acute laryngitis, they are often covered or ulcerated. If necessary, the doctor will take a swab to find out which pathogen has caused the inflammation.

If the results are inconclusive, a direct laryngoscopy may be necessary, which is performed under anaesthetic. An endoscope is pushed up to the larynx so that the doctor can examine the larynx directly with a microscope and also take a tissue sample. If laryngeal cancer is suspected, a laboratory analysis of the tissue sample will provide clarity. 

Treatment: What to do for laryngeal pain?

The exact treatment depends on what is causing your laryngitis. Acute laryngitis usually goes away on its own within a few days to two weeks. If bacteria are involved in the inflammation, your doctor may prescribe an antibiotic. 

In the case of laryngeal pain caused by chronic inflammation, the cause of the persistent irritation must first be found. Once it has been removed, the inflammation will also subside. This can be, for example, speech therapy treatment to learn the correct speaking technique so that the voice is no longer under so much strain. But it can also be treatment for reflux disease (heartburn) or allergies - or even giving up excessive alcohol consumption and smoking. 

Laryngitis: relieving pain

Even if the laryngeal pain of acute laryngitis goes away on its own, it is very unpleasant at first. Here we have collected a few tips and home remedies that can alleviate the pain - they will of course also help with chronic laryngitis. 

1. Save your voice 

The most effective treatment for laryngitis is to rest the voice as much as possible so that the vocal folds are not put under additional strain and can recover. Incidentally, it is not better to whisper - quite the opposite! Whispering puts even more strain on the vocal folds than normal speaking. So it's best to speak as little as possible.

2. Drink a lot 

Even if you have a sore throat when swallowing, please do not reduce your fluid intake. It is important to moisturise the mucous membranes sufficiently so that cold viruses can be flushed out easily. Warm (not hot) teas are ideal. Sage and ginger tea, for example, have an antibacterial effect and can relieve pain. Chicken broth is also a good choice. 

3. Inhalation  

Many people find inhaling hot water vapour and saline solution helpful and soothing. You can also add eucalyptus oil or camomile to the water. This allows you to reach the inflamed areas of the larynx much better than gargling.

4. Humidify room air

Dry and dusty air irritates the mucous membrane of the larynx. It is therefore advisable to humidify the room air slightly. Special humidifiers are available for this purpose. Alternatively, you can also hang damp cloths over the radiator or place a bowl of water on a radiator. But please don't overdo it here: If the air is too humid, mould can form, which can have a negative impact on your health.

5. Apply a neck compress

The classic home remedies for pain in the larynx are potato compresses and cottage cheese compresses. Potato compresses have a warming effect and curd cheese compresses have a cooling effect. Potato compresses dilate the blood vessels, improve blood circulation and relax the muscles. They are therefore particularly helpful for tense muscles. Curd cheese compresses have a decongestant and pain-relieving effect and are particularly beneficial for inflammation.

6. Avoid alcohol and acidic foods

Protect your already inflamed mucous membrane by temporarily avoiding alcohol and foods that can cause irritation. 

These include:

• Sour fruit juices
• Hot dishes
• Hot drinks and food
• Coffee

7. Quit smoking 

The toxins from cigarette smoke irritate the mucous membrane and are a common cause of chronic laryngitis. Acute laryngitis also heals better if the inflamed areas are not additionally exposed to cigarette smoke. Reduce smoking as much as possible. Ideally, of course, you should stop smoking completely.

8. Take anti-inflammatory and expectorant medication

Anti-inflammatory and expectorant medication can help with acute laryngitis that occurs at the same time as a respiratory tract infection. Pain-relieving lozenges can also provide relief. Ask your doctor or pharmacy for advice on this.

9. Strengthen the immune system

Strengthen your immune system so that your body can deal with inflammation better and faster. Avoid pro-inflammatory foods such as sugar and instead favour anti-inflammatory foods such as green vegetables, pulses, onions and garlic. Regular exercise in the fresh air and sufficient sleep also strengthen the immune system.