Larynx pain – causes and treatment

When the larynx hurts, it can be for a variety of reasons. Often it is just a dry throat or a mild respiratory disease. This is especially true if, in addition to the larynx, accompanying symptoms such as coughing or runny nose occur. Occasionally, however, the pain in the larynx also indicates a serious larynx disease. In the following article you will find out how best to correctly interpret the symptoms, when to see a doctor and how to treat the pain effectively in an emergency.

contents

• The larynx
• Causes of larynx pain
• Concomitant symptoms
  • Changes in the voice pattern
  • Difficulty swallowing (dysphagia)
  • Breathing problems
  • General symptoms of illness
  • Symptoms in reflux disease
  • Symptoms of thyroid diseases
  • Symptoms of trauma in the neck area
• diagnosis
  • Laryngoscopy
  • Computed tomography / magnetic resonance tomography
  • Sonography
  • Laboratory values
• therapy
• Home remedies
• Naturopathy
• Medical therapy
• Surgical therapy
• More options

The larynx

In order to understand how pain in the throat ( larynx may apply) you have to first look, at its structure more closely. The larynx is a highly complex organ located in the throat between the throat and the windpipe. It mainly consists of different cartilage, muscle and ligament structures and is particularly indispensable for voice training. This is because the air flows through the larynx when inhaling from the mouth and throat via the windpipe into the lungs and when exhaling back the same way.

You have to think of the larynx as the body’s own musical instrument that is made to sound by the air flowing through it. The most important and probably best known for the sound formation of this instrument is the voice-forming apparatus ( glottis ), which includes the vocal folds ( plica vocalis ) and the vocal cords ( ligamentum vocale ) attached to it . The latter are set in vibration by the airflow caused by breathing, which ultimately allows the creation of tones and sounds. If the vocal folds or vocal cords are irritated by unnatural external circumstances, laryngeal pain in this area is not uncommon. The pain is usually accompanied by a rough voice or hoarseness hand in hand.

The voice-forming heart of the “larynx instrument” is surrounded by three paired and three unpaired cartilages, which form the basic structure of the larynx and are also involved in voice formation. Existing cartilage damage or irritation can also lead to enormous pain in the larynx and sometimes even disable the voice function. Below is a brief overview of the cartilage structures of the larynx:

• Thyroid cartilage( Cartilago thyroidea ) – the largest larynx cartilage is unpaired and forms the “body” of the larynx instrument. In men, the thyroid cartilage also forms the Adam’s apple ( Prominentia laryngea ), which is responsible for the low pitch of the male voice.
• Cricoid cartilage( Cartilago cricoidea ) – this cartilage serves as a connecting piece between the upper and lower airways . Together with the adjusting cartilage, the cricoid cartilage forms a joint that is of particular importance for the formation of sounds.
• Stellate cartilage( Artilagines arytaenoidae ) – the paired positioning cartilages sit above the cricoid cartilage to the left and right of it. They are connected to a particularly large number of muscle fibers in order to be able to modify the sound-making structures of the larynx as best as possible when speaking, singing or screaming and as required.
• Squirrel cartilage( Cartilago corniculata ) – the squirrel cartilage, which sit on top of the anterior cartilage, is also arranged in pairs. As the name suggests, these cartilages are horn-shaped.
• Wedge cartilage( Cartilago cuneiformis ) – another pair of cartilage forms in the larynx, the wedge cartilage. They can only be recognized as small elevations in the laryngeal cartilage structure and are not connected to other cartilage structures of the larynx. Instead, they are surrounded and held in place by a series of muscles, similar to the anterior cartilage.
• Epiglottic cartilage( Cartilago epiglottica ) – the epiglottic cartilage makes it clear that the larynx has another important task in addition to voice formation. This is because he is responsible for ensuring that no pieces of food get into the windpipe when eating or swallowing. For this purpose, the larynx muscles fold down the epiglottic cartilage when swallowing, so that it covers the windpipe like a lid.

All these cartilaginous structures of the larynx are connected by various ligaments and muscles. The larynx muscles in particular are important for sound production, because they tighten and relax the vocal cords, which allows different tones to be formulated. For the tension of the vocal cords is Muskulus cricothyroideus , for the relaxation of thyroarytenoideus muscle responsible. If the said muscles are overused, for example by talking for a long time, muscle-related larynx pain is also possible. This can also affect the language function temporarily.

In addition, several nerves that control the complex interplay of the muscles in the larynx are also a possible cause of pain. These nerves arise primarily from the vagus nerve ( Nervus vagus ), better known as the tenth cranial nerve, which, in addition to the larynx, also controls the motor functions of the pharynx, the esophagus, the base of the tongue and the auditory canal. One of the reasons why pain in these structures adjacent to the larynx is often incorrectly interpreted as larynx pain. Because pain symptoms in the throat , hearing as well as the mouth and throat area radiate relatively easily to the larynx via the nerve network described .

Causes of larynx pain

As already shown, in the case of larynx pain, a distinction must be made between pain symptoms located directly in the larynx and radiation pain. Radiation pain is mainly caused by classic ENT diseases, such as a

• Cold,
• Flu,
• Tonsillitis,
• Ear infection,
• Sore throat

but also triggered by thyroid disease.

In particular, pharyngitis is a frequent cause of radiation pain due to its proximity to the larynx and makes a clear diagnosis difficult due to accompanying symptoms such as hoarseness , sore throat and swallowing problems , which can just as easily result from a larynx disease.

When it comes to pain actually localized in the larynx, laryngitis is probably the most common cause of the disease. There are five different forms of illness:

Acute laryngitis – the vocal folds and thus the vocal cords are particularly affected by the inflammation. In addition to larynx pain, the most common accompanying symptoms are hoarseness and temporary loss of voice. The upper part of the windpipe can also be involved in the disease process, which then causes additional breathing difficulties. Acute laryngitis is particularly often triggered by previous viral infections.

Phlegmonous laryngitis – a relatively rare, but all the more dangerous form of laryngitis . It primarily affects the ligament and muscle structures of the larynx and is commonly triggered by serious infectious diseases such as diphtheria, syphilis , tuberculosis or typhoid . Phlegmonous laryngitis can be fatal as the infectious agents responsible reduce the immune system. A high fever, swallowing problems and life-threatening breathing disorders cannot be ruled out with this form of larynx infection.

Chronic laryngitis – laryngitis becomes chronic primarily through persistent irritation, such as those caused by smoking or working in a dusty and dry environment. Chronic pre-existing illnesses such as acid reflux, chronic bronchitis or incorrect stress on the vocal cords, for example due to incorrect voice technique, can also be the cause. Any laryngitis that lasts longer than three weeks is to be regarded as chronic.

Laryngopharyngitis – due to the direct connection between the pharynx and larynx, pharyngitis and larynx inflammation often occur together. Most of the time, pharyngitis spreads to the larynx as the disease progresses because it was not treated in time or was insufficiently treated. Since the course usually extends over a period of more than three weeks, laryngopharyngitis is also often chronic.

Subglottic laryngitis – better known as croup , this form of laryngitis is an inflammation of the larynx below the glottis. Hoarseness and a barking cough are typical of this form of laryngitis. As in acute laryngitis, the potential inflammatory pathogens mostly originate from viruses. The following are among others:

• Adenoviruses,
• Eppstein-Barr Viruses,
• Herpes viruses,
• Influenza viruses,
• Measles virus,
• Metapneumoviruses,
• Rhinoviruses,
• RS viruses
• or chickenpox viruses.

In addition to laryngitis , other diseases can affect the vocal organ, which bring laryngeal pain as an accompanying complaint. These include, above all, cancer of the larynx and the broken larynx ( laryngocele ). The latter describes a bulging of the larynx pouch – a mucous membrane protuberance inside the larynx. Damage to the larynx, for example from external violent trauma, is also a possible cause of the pain. The chronic overload of the vocal cords from long speeches or singing units are also the main causes of painful hoarsenessnot to underestimate. In this context, some risk groups should also be mentioned, who relatively often suffer from larynx pain or painful laryngitis caused by irritation of the vocal cords. This includes:

• teacher,
• Singer,
• actor
• or professional speakers (for example cabaret artists or politicians).
• Concomitant symptoms
• As shown, larynx pain occurs in the context of very different clinical pictures and can accordingly also be of very different severity and intensity. For example, there may be a slight hoarseness in the throatwith forced throat This means that those affected only notice a slight scratchy throat and try to fix it by constantly clearing their throat. As the disease progresses, the hoarseness can develop into a pronounced feeling of dryness with an urge to cough. In most cases, the cough remains unproductive, so there is no expectoration of mucus from the upper respiratory tract. Depending on the cause, the event can develop into a severe sore throat with a clearly perceptible foreign body sensation in the throat area. Those affected then describe a significant tightness or a feeling of a lump in the throat , which cannot be remedied by swallowing and clearing throat more often. The pain is usually perceived as dull and oppressive and can radiate into the ear area. In the context of inflammatory processes, the pain can also be perceived as burning or stabbing.

Changes in the voice pattern

If the larynx is abnormally changed, this can be expressed by a clearly perceptible change in the voice pattern. This can often be seen in the fact that the person concerned is strained to speak or the voice is completely absent. Changes in pitch or unwanted whispering also occur here. Most of the time the cause is related to the vocal cords. Occasionally, however, space-consuming processes or as a postoperative complication can lead to paralysis of the recurrent nerve, which is significantly involved in voice formation.

Difficulty swallowing (dysphagia)

Both a painful event in connection with inflammatory processes and the growth of degenerate cells in the throat area can lead to more or less pronounced swallowing difficulties as the disease progresses. Not infrequently, this symptom leads to the point that even swallowing spit causes severe pain. Difficulty swallowing is associated with a lot of suffering for those affected, as they afflict a vital activity with pain, and they should therefore be treated with the treatment of the underlying disease.

Breathing problems

Breathing problems in connection with pathological processes in the area of ​​the larynx can have two causes. They either result from swelling of the lining mucous membranes in the area of ​​the airways , for example as a reaction to inflammatory processes, or breathing problems arise because the airways gradually become narrower due to the growth of degenerate cells.

General symptoms of illness

Diseases of the larynx can be accompanied by very general symptoms, such as those known from colds. These include:

• Light fever,
• Runny nose,
• Pain in the sinuses,
• Exhaustion
• and loss of performance.

If there is a significant weight loss, this may be due to reduced food intake as a result of possible swallowing difficulties. Sometimes, however, there is also a sometimes very rapid weight loss in the context of cancer growth. A large and unwanted weight loss for no apparent cause is therefore always a warning signal and should be investigated more closely.

Symptoms in reflux disease

In reflux disease , the gastric acid refluxes into the esophagus as a result of a decreased obstruction of the stomach entrance and an overproduction of gastric acid. This effect is perceived as heartburn. The gastric acid reflux is very common at night when the person is lying flat in bed. In this case, the stomach acid can even flow back to the throat and irritate the larynx area there. Hoarseness, difficulty swallowing as a result of irritation of the larynx and the need to clear the throat can point to reflux disease, especially if they occur mainly in the morning after getting up and regress again during the day.

Symptoms of thyroid diseases

The possibilities of thyroid diseases are very diverse. There is an overactive thyroid and an underactive thyroid , autoimmune processes in the thyroid and degeneration of the thyroid tissue, all of which, due to their anatomical proximity, can also cause symptoms in the larynx. For example, there can be clearly perceptible and recognizable soft tissue swelling in the neck area. Changes in the voice pattern and a feeling of lump in the throatare not infrequently described by people with thyroid disease. Since the thyroid gland produces hormones that regulate complex processes in the body, a thyroid disease can also affect various other areas in the body and cause several accompanying symptoms:

• Depressed mood
• Mood swings,
• Poor concentration,
• rapid exhaustion,
• inner restlessness,
• Tendency to be overweight or underweight
• and too long cycles or unfulfilled desire to have children in women.

Symptoms of trauma in the neck area

Frequently as a result of car accidents, but also in connection with sports and combat injuries, traumatic effects on the larynx can occur. This manifests itself in very severe pain and often in externally recognizable bruises. If the inside of the larynx is damaged, small or large amounts of blood may be coughed up. In this case, an emergency doctor should be called as soon as possible, as this is a potential emergency situation.

diagnosis

Pain described in the anamnesis discussion and its localization, severity, duration, type and accompanying symptoms are the first indications. The decisive finding, whether it is actually a pathological occurrence in the larynx itself or a change in the surrounding anatomical structures or more distant body regions, is then provided by one or more of the following imaging methods.

Laryngoscopy

Laryngoscopy provides images of the nature of the surroundings of the larynx from the throat. Two examination methods are available for this:

• Indirect laryngoscopy – a mirror is passed through the mouth to the back of the pharynx and then adjusted so that the larynx is visible from above. This method provides a very uncomplicated first impression of the condition of the larynx and the condition of the lining of the mucous membrane. The functionality of the vocal folds can also be checked. If the doctor allows those affected to breathe deeply during the examination, the breathing position of the vocal cords can be inspected. If the syllable “hi” is spoken during this, the phonation position of the vocal folds can also be examined. Nowadays this method is actually only used to get a first impression.
• Direct laryngoscopy – a thin endoscope (flexible or rigid) is inserted over the mouth or more often over the nose and advanced to the larynx. At the end of the endoscope there is a camera that allows better assessment due to its rotatable lens. In this way, mucosal growths and even the smallest changes in the mucous membrane can be recognized. Biopsies can also be taken directly from the changed tissue via a second working channel.
• Computed tomography / magnetic resonance tomography
• With these procedures, sectional images of the area of ​​the neck are made from the outside. Affected people have to lie still, but they are spared having to insert devices into the mouth and throat. CT and MRT examinations are used, among other things, to detect changes and injuries to the cartilage structure, for example in the context of a fall or accident. In addition, these examinations can be used to assess the extent and depth of growth of tumorous tissue and measure it with millimeter precision.
• Sonography
• Ultrasound examinations are used to assess the soft tissues in the neck area under low radiation exposure. For example, the numerous lymph nodes in the neck area can be examined in terms of their size and texture in order to obtain information on possible inflammation or colonization with degenerate cells. In the context of thyroid diagnostics, sonography is also of particular importance, because it provides information on the size, structure, possible lumps and foci of inflammation in the thyroid tissue. This may be followed by a functional test of the thyroid gland (thyroid scintigraphy).
• Laboratory values
• Some causes of larynx pain can be diagnosed by laboratory tests. For example, can be achieved by a swab from the throat, the type of pathogen to determine if a laryngitis( laryngitis ) is at the center of medical treatment. The typical inflammation values ​​can often be detected in the blood . The blood should also be used as a diagnostic medium in the context of thyroid diagnostics. Not only the amount and concentration of thyroid hormones can be measured in it, but also possible antibodies as an indication of an autoimmune disease ( Hashimoto’s thyroiditis) can be detected in the blood. Tumor markers can also be detected in the blood as the first indication of a cancer event or their values ​​will be increased. However, there are no specific tumor markers that would limit the cancer to the area of ​​the neck.

therapy

In connection with larynx pain, there are numerous therapeutic approaches, the selection and use of which of course depend very much on the triggering cause.

Home remedies

The repertoire of home remedies related to laryngeal pain is particularly important when it comes to inflammation. In the first instance, those affected should refrain from speaking and completely avoid particularly strenuous speech types such as whispering and singing. Those affected should not expose themselves to an irritating environment (dust exposure, indoor swimming pool) and irritating substances ( smoking ). The throat should be kept moist as much as possible. Drinking a lot, sucking herbal candies and inhaling can help here. When staying outdoors, the neck should be kept protected (scarf or shawl). In the case of very pronounced pain conditions, cold compresses can be applied from the outside. Even Quark packsachieve very good, pain relieving results here. For this you put a portion of room-warm, commercially available low-fat quark on a cloth and wrap it around your neck from the outside. A second cloth provides additional hold and prevents the dressing from drying out. You can leave this wrap on your neck until the quark has reached body temperature.

Naturopathy

Moistening and keeping the neck moist is a major therapeutic goal in connection with larynx pain and can be very well pursued with naturopathic means. The following herbs can be used as extracts in the hot steam bath, inhalation, tea, lollipops, throat rinsing solution or cough syrup:

• Sage,
• Tea tree oil,
• Icelandic moss,
• chamomile
• or ribwort.

Medical therapy

If inflammation is responsible for the larynx pain, symptomatic painkillers are used, which also have an anti-inflammatory effect as a side effect. Antibiotics are used when bacteria are suspected to be pathogens. In the case of particularly serious and therapy-resistant inflammations, drugs containing cortisone can also be used. They are available in tablet form, as an infusion solution or as an active ingredient in inhalation sprays or solutions. In particular, the inhalation of cortisone or other additives can be used very effectively to break the vicious circle of irritated mucous membranes, coughing and the resulting further irritation of the mucous membranes.

For those affected with a thyroid disease as the cause of the larynx complaints, two therapeutic approaches come into play: Substitution of the missing thyroid hormones in the case of an underactive thyroid or inhibition of thyroid activity in the case of an overactive thyroid .

Surgical therapy

According to the German Cancer Society, throat cancer represents the lowest proportion of cancers of the upper respiratory tract and food tract, but due to its therapeutic approaches it is one of the types of cancer with the highest psychological stress. In addition to an adapted cytostatic and radiation therapy, surgical removal of the tumorous tissue is a frequently used option. It is not uncommon for the larynx to have to be removed in large parts. As a result, those affected have to wear a tracheostomy tube temporarily or for life to secure the airway .

Even with thyroid dysfunction, surgical removal is sometimes considered. However, these are mostly thyroid tissue, which is suspicious in the imaging and suspected of containing degenerate cells.

More options

In homeopathy, two remedies are very popular for treating larynx problems:

• Argentum metallicum: Used for people with severe problems with speech and voice. For example, if the vocal cords are still irritated after the larynx has been overcome.
• Schüßler Salt 11 – Silicea: is used very promisingly, especially for chronically recurring inflammations of the tonsils (tonsilitis) that can spread to the larynx.