Laryngitis.

How is it assessed? Laryngeal symptoms may have many causes. They are usually driven by four broad disease processes: inflammation, neoplastic and structural abnormalities, imbalance in muscle tension, and neuromuscular dysfunction. Laryngeal symptoms arise from one or a combination of these processes. A careful history and examination is crucial in determining the primary factor and helping to identify other factors leading to persisting symptoms. The first consideration in the initial assessment of patients with laryngeal symptoms should be airway patency. Patients with stridor or respiratory distress need urgent assessment in a setting where airway support can be provided quickly if needed. Having assessed the airway, the history should cover the nature and chronology of voice symptoms, any exacerbating and relieving factors, and the patient’s voice use and requirements. In addition to the description of vocal problems, it is important to ask about associated symptoms of dysphagia, odynophagia, otalgia, reflux, globus pharyngeus, weight loss, pulmonary health, and choking. Box 1 outlines the red flag symptoms that should prompt an urgent referral to exclude malignancy. Contributing medical conditions or the effects of treatment should be considered, as should lifestyle factors, including smoking, diet, and hydration. The impact on quality of life and psychosocial wellbeing should also be addressed. Investigations include a general head and neck examination covering the oral cavity, oropharynx, and neck, and an assessment of the patient’s voice. This can be done by way of a simple scale: grade 1 (subjectively n ormal voice), grade 2 (mild dysphonia), grade 3 (moderate dysphonia), grade 4 (severe dysphonia), and grade 5 (aphonic), with addiLaryngitis