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Nursing Guide to Laryngitis: Nursing Diagnosis, Interventions, & Care Plans

Updated On 8 Minute Read

Laryngitis Etiology and Epidemiology 

Laryngitis is an inflammation of the mucosa of the larynx. Laryngitis is typically accompanied by a hoarse voice and discomfort in the anterior neck (DynaMed, 2018). It can be an acute or chronic condition. Most often, laryngitis is caused by a viral infection and is self-limiting. If laryngitis lasts for > 3 weeks, it is considered to be chronic. Acute laryngitis affects individuals from ages three and up, but it is more common among those 18 to 40 years old. 

The most common cause of acute laryngitis is an upper respiratory infection from a virus (Gupta & Mahajan, 2021). Other symptoms an individual with laryngitis might present with include: 

  • Change in voice that can range from hoarseness to a complete loss of voice
  • Vocal fatigue (i.e., voice fades after talking for a short time)
  • Dry cough
  • Postnasal drip
  • Head congestion
  • Poorly controlled asthma, wheezing, cough, or chest tightness
  • Lump in the throat 

The classifications of laryngitis are infectious or noninfectious. The infectious type is most common. Infectious laryngitis typically presents after an upper respiratory tract infection (URI). The viral agents responsible for causing laryngitis are: 

Laryngitis causes by bacterial infections usually occur as a secondary infection after a virus. This type of laryngitis occurs approximately 7 days after the viral infection (Gupta & Mahajan, 2021). The most common bacteria causing laryngitis are streptococcus pneumoniae, Moraxella catarrhalis, or Haemophilus influenza. 

A febrile illness can also cause laryngitis, so it is essential to get a vaccination history. The febrile illnesses include: 

A fungal infection can also cause laryngitis, but it is rare in a person who is not immunocompromised. The cause of a fungal infection is typically related to inhaled steroid use from improper oral rinsing after the treatment. 

 It is important to remember that in children, laryngotracheobronchitis (croup) can also present as laryngitis in the early stages then progress to the barking cough and inspiratory stridor. 

Noninfectious laryngitis may occur from: 

An individual with laryngitis from vocal misuse could be a sports fan or concertgoer who has done a lot of screaming. Laryngitis caused by GERD can accompany other signs of gastric reflux or present only as laryngitis. Symptoms of laryngitis from GERD can be acute or chronic and are typically episodic. At least one-third of the individuals with GERD have only laryngitis as a symptom. 

Asthma can predispose a person to laryngitis from a chemical irritation after inhaler use. A steroid inhaler for asthma flares can cause fungal laryngitis from not drinking enough water after use. Seasonal allergies, environmental causes, and air pollutants can irritate the vocal cords and trigger laryngitis. 

When a virus or bacteria settle in the larynx, there is localized congestion. For the inflammation to heal, white blood cells settle in the local area, causing vocal cord edema. The edema affects the vibration of the cords, changing the amplitude, frequency, and magnitude of the sound produced by speech. If the swelling becomes severe, it can cause complete loss of speech. It is best to make a referral to an otolaryngologist if laryngitis lasts longer than 2 weeks. 

Laryngitis Diagnosis 

Starting with a thorough history is the best first step to diagnosing laryngitis. Asking questions such as: 

  • Recent upper respiratory infections (cold or influenza)
  • Recent exposure to anyone who was sick
  • Vaccine history
  • Recent travel
  • Diagnosis of GERD
  • Onset and duration of symptoms
  • Previous history of laryngitis
  • Pain or discomfort in the throat
  • Recent cough
  • Recently attended a sports event or concert
  • Previous vocal fatigue 

Diagnosis of laryngitis can be entirely based on the history findings. The larynx should also be visually examined for edema. Visualizing the larynx requires a mirror with a long handle or a flexible laryngoscope. 

Laryngitis Management 

Most treatment for acute laryngitis is supportive and can depend on the severity of illness. Treatments may include: 

  • Complete voice rest is recommended. It is crucial not to talk while recovering. If speaking is necessary, then a whisper voice should be used.
  • Avoid irritants such as smoke and pollution.
  • Steam inhalation or humidified air will moisten the upper airway and makes it easier to clear secretions.
  • Dietary modifications if GERD is the cause can help. Avoid foods such as caffeine drinks, fatty food, or spicy food.
  • Antibiotics are not typically used to treat laryngitis; however, they may be given for severe symptoms or high-risk individuals.
  • Oral antifungals such as fluconazole (Diflucan®) can treat fungal laryngitis.
  • Mucolytics such as guaifenesin (Mucinex®) can be used to thin out irritating secretions.
  • Gastroesophageal reflux medications such as omeprazole (Prilosec®) may be used to control GERD. 

Treatment for chronic laryngitis aims to treat the underlying cause such as smoking, alcohol consumption, or GERD. 

In some instances, medications are used to treat laryngitis. These medications include: 

  • Antibiotics only help if a secondary bacterial infection is causing laryngitis, such as a sinus infection.
  • Corticosteroids are occasionally given to help decrease vocal cord inflammation. This option is only used to treat small children with croup. 

Sometimes surgery is needed to treat laryngitis if the cause is a tumor or polyp that has to be removed. After severe laryngitis or vocal cord surgery, voice therapy may be required to re- establish a good speaking voice. 

Laryngitis Nursing Care Plan

Nursing Considerations 

Use the nursing process to develop a plan of care for individuals. The nursing assessment (with common findings listed), diagnoses, interventions, expected outcomes, and education for laryngitis are listed below. 

Assessment 

Assess signs and symptoms, such as: 

  • Vital signs
  • Presence of cough or stridor
  • Breathing status
  • Lung sounds
  • Ability to swallow
  • Ability to tolerate eating food or drinking liquids
  • Symptoms of GERD:
    • Burning sensation in the chest after eating or at night
    • Difficulty swallowing
    • Regurgitation of food
    • Feeling sensation of a lump in the throat
    • Chronic nocturnal cough
    • Recurrent laryngitis
    • Disrupted sleep
    • Increased asthma symptoms
  • Smoking history
  • History of alcohol consumption
  • History of recent illness in the individual or household member
  • Intake and output
  • Postnasal drip
  • Blood in throat or sputum 

Laryngitis Nursing Diagnosis/Risk For 

  • Ineffective airway clearance related to laryngitis as evidenced by (Phelps, 2021a):
    • Presence of thick mucus
    • Edema of the larynx
  • Deficient knowledge related to complications of laryngitis as evidenced by (Phelps, 2021b):
    • Preventing complications
    • Promoting recovery
  • Risk for deficient fluid volume related to poor fluid intake as evidenced by (Phelps, 2021c):
    • Inadequate fluid intake
    • Inability to tolerate swallowing liquids 

Laryngitis Interventions 

  • Check vital signs
  • Encourage voice rest, avoid talking
  • Monitor airway patency
  • Position in a semi fowler to high fowlers position
  • Help the individual to avoid irritants such as chemical inhalants or allergens such as pollen
  • Teach proper hand hygiene
  • Encourage gargling with salt water to decrease pain and swelling
  • Promote a healthy diet in the most manageable texture for the individual to swallow
  • Encourage drinking cool temperature fluids as often as possible
  • Provide cool humidified air
  • Administer and educate on medications if ordered
  • Encourage to stop smoking
  • Review at-home care for laryngitis:
    • Room humidifier
    • Avoid irritants
    • Avoid foods or liquids that may cause GERD
    • Avoid spreading germs (proper handwashing) 

 Expected Outcomes 

  • Decrease laryngeal swelling
  • Return of vocal ability
  • Improvement of symptoms 

Individual/Caregiver Education 

  • Condition, treatment, and expected outcomes
  • Notify healthcare provider or seek immediate medical care for:
    • Laryngitis that lasts longer than 14 days
    • Temperature ≥ 101°F
    • Worsening symptoms
    • Difficulty breathing
    • Presence of large tender lumps in the neck
    • Increased throat pain
    • Bleeding in the throat or sputum
    • Chest tightness
    • Difficulty swallowing
    • Neck swelling or difficulty moving neck
    • Dizziness or lightheadedness
  • Replace toothbrush frequently
  • Avoid being around anyone who is immunocompromised while sick
  • Avoid decongestant medications that can dry out the throat 

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Additional Information

Content Release Date

4/1/2022

Content Expiration

12/31/2027

Course Contributor 

The content for this course was created by Kathleen Koopmann, RN, BSN, PCCN. Kathleen earned her Associate Degree in nursing in 1987 at Mid-Michigan Community College and her Bachelor of Science in nursing in 2018 from Western Governor’s University. She has training from the North Carolina Statewide Program for Infection Control and Epidemiology through NCDHHS and the University of North Carolina. Kathleen has worked in long-term care, outpatient care, acute care, and nursing education. She has hospital experience in Med-Surg, OR/PACU, Critical Care, Telemetry, and outpatient experience in Occupational Health. Kathleen has experience as a clinical instructor for the LPN program at Susquehanna County Career and Technical Center in Pennsylvania. Most recently, she worked in long-term care as a Staff Development Coordinator and Infection Control Practitioner. 

 Resources 

References 

  • DynaMed. (2018). Hypertensive crisis. https://www.dynamed.com/condition/hypertensive-crisis#DESCRIPTION  
  • Gupta, G., & Mahajan K. (2021). Acute laryngitis. StatPearls Publishing; Jan-. https://www.ncbi.nlm.nih.gov/books/NBK534871/ 
  • Phelps, L. L. (2021a). Sparks and Taylor’s nursing diagnosis pocket guide (4th ed., pp. 72-74, 607-609). Wolters Kluwer. 
  • Phelps, L. L. (2021b). Sparks and Taylor’s nursing diagnosis pocket guide (4th ed., pp.325- 327). Wolters Kluwer. 
  • Phelps, L. L. (2021c). Sparks and Taylor’s nursing diagnosis pocket guide (4th ed., pp. 214- 216). Wolters Kluwer. 

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Kathleen Koopmann, RN, BSN, PCCN

Kathleen earned her Associate Degree in nursing in 1987 at Mid-Michigan Community College and her Bachelor of Science in nursing in 2018 from Western Governor’s University. She has training from the North Carolina Statewide Program for Infection Control and Epidemiology through NCDHHS and the University of North Carolina. Kathleen has worked in long-term care, outpatient care, acute care, and nursing education. She has hospital experience in Med-Surg, OR/PACU, Critical Care, Telemetry, and outpatient experience in Occupational Health. Kathleen has experience as a clinical instructor for the LPN program at Susquehanna County Career and Technical Center in Pennsylvania. Most recently, she worked in long-term care as a Staff Development Coordinator and Infection Control Practitioner.