Laryngitis (Swelling of voice box) – Causes, Ayurvedic Treatment

By Dr Raghuram Y.S. MD (Ay).
Voice is the best media given by the creation to put-forth our expressions and emotions in right form. Our voice is our identity and it defines our personality. We often feel frustrated when we want to tell something and there is something or someone posing an obstruction to it. 

We all have liberty to speak but voice is a treasure which we need to take care of. Ayurveda too has mentioned ‘Vak’ i.e. speech or ‘Vagindriya’ i.e. organs of speech as important Karmendriya (motor organs).

Our voice and apparatus of its production too undergo stress, wear and tear just like any other cell in our body. Voice is easily afflicted and disturbed by the influence of the way in which we handle our speech (loud and excessive speaking, singing loudly for many hours etc), the diet we take, our lifestyle, our habits (smoking, drinking alcohol etc), infections, injuries, our geography and environmental conditions.
We come to know that we have a voice only when it is disturbed!!!

Laryngitis or swelling of our voice box (apparatus which produces our sound and voice) is a condition which puts our voice into trouble, sometimes so troublesome that makes us mute.

We will try to learn more about this condition through this article and to sort out best treatment options from the perspectives of both Ayurvedic and modern medicines.

Laryngitis

Laryngitis is the inflammation (swelling) of the larynx or voice box, occurring due to overuse, irritation or infection

Causes

• Hoarseness of voice
• Temporary loss of voice
• Complete loss of voice

This happens due to irritation of the vocal folds or vocal cords.
Vocal or voice related disorders are called Dysphonia
Laryngitis is one of the causes of Dysphonia or voice disorders
Laryngitis is contagious only if it is caused by an infection.

How to prevent laryngitis?

• Don’t smoke, avoid second-hand smoke. Smoke dries and irritates your vocal cords.
• Limit alcohol and caffeine – they can deplete your body water stores
• Drink plenty of water – fluids keep the mucus in your throat thin and easy to clear
• Avoid spicy foods – These foods move stomach acid into your throat or food pipe (oesophagus) causing heartburn or gastritis.
• Include whole grains, fruits and vegetables in your diet – They contain Vitamins A, E & C and help keep the mucus membranes that line the throat healthy
• Avoid throat clearing – This further hurts your throat as it causes an abnormal vibration of your vocal cords and can increase swelling. Clearing your throat also causes your throat to secrete more mucus and feel more irritated, making you want to clear your throat again
• Avoid upper respiratory tract infections – Wash your hands often. Avoid contact with people who have upper respiratory infections such as colds

Tips and Home Remedies

• Rest voice: Rest is the key to recovery and holds good in all sorts of illness especially inflammations.
• If talking is inevitable – talking in a regular voice is better than whispering. Whispering needs the vocal cords to be stretched tightly and requires more work by the surrounding muscles and delays recovery time
• Use humidified air: Inhale steam from a bowl of hot water or a hot shower
• Keep good hydration (drink lot of water)
• Warm water gargles
• Popsicles
• Avoid caffeine and alcohol
• Moisten your throat – Try sucking lozenges, gargling with salt water or chewing a piece of gum

Steam inhalation

Steam inhalation for laryngitis:
Take 5 cups of water in a wide mouthed vessel. Heat it. Put 5 drops of Eucalyptus oil or pine oil to it. Inhale the steam for 5 minutes. Repeat it 3 – 5 times in a day.
Inhalation loosens the secretions and consolidated phlegm

Ayurvedic home remedies

Ayurvedic Home Remedies for Laryngitis:

• Crush 8-10 Tulsi (basil) leaves and extract their juice. Mix it with 1 spoon honey and take it.
• Take 6-8 Basil leaves along with 2 pepper grains and a pinch of rock salt. Chew them and slowly suck the juice.
• Lime juice 2 spoons mixed with honey 1 spoon, hourly once
• Add 1 spoon of Cinnamon powder to boiling water and close the glass with a lid. When it becomes warm, add a pinch of pepper powder and 2 spoons honey. Take it once or twice daily.
• Boil ½ to 1 teaspoon full of liquorice (coarse powder) in 1 glass of water, filter and consume warm or mix ½ teaspoon full of liquorice (fine powder) in hot milk and take it to get relieved from laryngitis. If liquorice is boiled until half water is reduced, it provides better results. Even with milk – half glass milk and half glass water should be boiled with liquorice powder until half of it evaporates and consumed.
• ¼ spoon honey + ¼ spoon ginger juice – should be taken in drops and slowly sucked
• ½ – 1 spoon of Amla (Indian gooseberry) powder, 1 spoon sugar candy powder and a pinch of pepper powder added to hot milk
• Ghee + jaggery
• Crush or chop ½ onion, boil it with 1 glass of water for 5 -10 minutes, strain it through a sieve, add 1 spoon honey and 2 spoon lemon juice to it. Sip it slowly.
• ½ spoon butter + 2 pinch pepper powder – 3-4 times per day
• Milk boiled with 1 spoon turmeric powder and added with sugar candy powder (1/2 spoon) and a pinch of pepper
• Laja churna – Powder of puffed paddy or parched rice should be given mixed with honey
• Honey and Ghee mixed in unequal quantities
• Grated ginger or ginger paste + Liquorice powder + pinch of Black pepper powder + Honey – 2-3 servings per day
• Juice of Vasa (Adhatoda vasica) 1 spoon + Honey 2 spoons
• Kulattha churnam – Powder of horse gram kept in mouth and sucked over a couple of minutes
• Paste of ber leaves (Indian jujube) fried in ghee should be given mixed with Saindhava Lavana (rock salt) to alleviate laryngitis associated with cough
• Khadira – (Acacia catechu) – kept in mouth (for sucking as lozenges) mixed with either of sesame oil or powder of Piper longum or powder of Zingiber officinale cures Swarabheda

Easy gargles:

• Garlic juice mixed in warm water
• Salt water
• Water boiled with basil leaves
• Turmeric powder + Ginger juice + Basil juice + Rock salt + Warm water
• Decoction of – Clove + Cinnamon + Salt + Cardamom + Basil leaves + Neem Leaves + Turmeric powder

When to see a doctor?

Most cases of Laryngitis can be managed by self-care such as voice rest and drinking plenty of fluids
Strenuous use of your voice during an episode of acute laryngitis can damage your vocal cords
See your doctor if your laryngitis symptoms last more than 2 weeks
Seek immediate medical attention if you have:

• Trouble in breathing
• Blood in cough
• Fever that isn’t going away
• Trouble in swallowing

If your child:

• Makes noisy, high pitched breathing sounds when inhaling (stridor)
• Drools (drops saliva uncontrollably from mouth) more than usual
• Has trouble swallowing food and liquids
• Has difficulty in breathing
• Has fever higher than 103 F (39.4 C)

Related terms

Larynx – brief anatomy:

• Larynx is the voice box located in the front of our neck
• It produces our voice
• It allows us to speak, shout, whisper and sing
• Larynx is made up of a cartilaginous skeleton
• Vocal cords, the vibration of which produces our voice is located within the cartilaginous skeleton and is covered by a protective mucus lining

Voice production:

• There are a few muscles inside the larynx. These muscles adjust their position, shape and tension of the vocal cords. These adjustments allow us to make different sounds from whispering to singing.
• Any change in the air flow (generated by the lungs exhaling air) across the vocal cords will affect the voice and the quality of the sound

Location: The larynx is located at the junction of the mouth and trachea. It has a flap-like covering called the epiglottis. Epiglottis prevents food and saliva from entering the larynx during swallowing.

Types:
Acute Laryngitis (Short lived) – Laryngitis lasting less than 3 weeks

Chronic Laryngitis (Long Lasting) –

• Laryngitis lasting more than 3 weeks
• Occurs in middle age
• More common in men than women

Antibiotics are not useful in acute laryngitis

Signs and Symptoms

Primary symptoms:

• Hoarseness or inability to speak
• Loss of voice
• Throat pain

Other symptoms:

• Dry or sore throat
• Burning throat
• Coughing (cough is both a causative factor and symptom of Laryngitis)
• Dysphagia (Difficulty in swallowing)
• Sensation of swelling in the area of the larynx
• Cold or flu-like symptoms (can also be a cause and symptom of laryngitis)
• Swollen lymph nodes in the throat, chest or face
• Fever
• Coughing of blood
• Shortness of breath (predominantly in children)
• Increased production of saliva
• Pain with swallowing
• Fullness in the throat or neck
• Chronic inflammation due to laryngitis may cause formation of nodules or polyps on the vocal cords

Infectious laryngitis

• Fever
• Swollen lymph nodes

Symptoms in infants and children (symptoms caused by infection):

• Croup – breathing becomes difficult
• Hoarse barky cough
• Fever

Croup (Laryngo-tracheo-bronchitis) – It is a respiratory condition which is usually triggered by an acute viral infection of the upper way. The infection leads to swelling inside the throat, which interferes with normal breathing. It produces the classical symptoms of a barking cough, stridor (harsh sound) and hoarseness. It may produce mild, moderate or severe symptoms. Symptoms often worsen at night.

Causes

Causes of acute laryngitis:
Most cases of laryngitis are temporary and improve after the underlying cause gets better. Causes of such type of acute laryngitis are:

• Viral infections similar to those that cause a cold
• Vocal strain, caused by yelling or overusing your voice
• Bacterial infections, such as diphtheria (rare, due to increasing rates of vaccination)

Causes of Chronic Laryngitis may be caused by

• Inhaled irritants, such as chemical fumes, allergens or smoke
• Acid reflex also called as GERD (Gastro-oesophageal Reflex Disease)
• Chronic sinusitis
• Prolonged and excessive alcohol use
• Smoking
• Constant exposure to second-hand smoke
• Exposure to polluted air
• Excessive coughing
• Habitual overuse of your voice (singers, cheerleaders etc)
• Bacterial or fungal infections (less common)
• Infections with certain parasites (less common)

Other causes of chronic laryngitis:

• Cancer
• Vocal cord paralysis (due to stroke, injury, lung tumour etc)
• Bowing of the vocal cords in old age

Non-infectious causes:
Gastro-oesophageal reflex disease (GERD) – Acid-reflex disease resulting in Laryngitis Gastrica

GERD – may cause reflex laryngitis and chronic cough. This happens when acid and digestive juices from the stomach reflux up into the oesophagus (food pipe) and back into the throat.
People will be aware of the presence of the acid. They will experience water-brash, sour taste in their mouth

Repeated spills of acid (reflux) onto the vocal cords will cause a chemical irritation and result in inflammation and swelling of the cords. This hinders appropriate vibration and generation of sounds

• Reflux Laryngitis – usually caused by GERD as explained above
• Polyps and nodules: Chronic irritation of vocal cords may cause polyps or nodules to form on the vocal cords. This will affect the ability of the vocal cords to vibrate. This in turn causes hoarseness of voice.
• Stroke – This may cause vocal cord muscle paralysis leading to a weak hoarse voice and swallowing problems
• Trauma – damage to the muscles or nerves controlling the vocal cord may lead to hoarseness. The nerves may be damaged if there has been trauma to the neck or if surgery has been performed and the nerves irritated or severed
• Tumours – Tumours in the neck and chest may compress the nerves and cause them to function poorly
• Thyroid inflammation & enlargement – This causes irritation of nerves that supply vocal cord muscles
• Allergies
• Excessive coughing
• Excessive smoking
• Excessive alcohol consumption
• Inflammation caused due to over use of vocal cords – due to talking, shouting, singing loudly
• Prolonged use of inhaled cortico-steroids for Asthma treatment
• Thermal or chemical burns
• Laryngeal trauma – including iatrogenic one caused by endotracheal intubation
• Exposure to second hand smoke
• Exposure to polluted air
• Chronic irritation to vocal cords

Infectious:
Includes – Upper respiratory infection or cold

Viral laryngitis – can be caused by

• Rhinovirus
• Influenza virus
• Para-influenza virus
• Adenovirus
• Coxsackie virus
• Corona virus
• RSV

Bacterial laryngitis can be caused by

• Group A streptococcus
• Streptococcus pneumonia
• Diphtheriae
• Catarrhalis
• Haemophilus influenza
• Bordetella pertussis
• Bacillus anthracis
• Tuberculosis

Note: Bacterial infections usually follow pre-existing viral infection

Fungal Laryngitis – Can be caused by

• Histoplasma
• Blastomyces
• Candida
• Cryptococcus (rare)
• Coccidioides (rare)

Symptoms of infectious laryngitis in adults:

• Upper respiratory tract infection or cold
• Dry cough
• Sore throat
• Fever
• Swollen lymph glands in the neck
• Pain with swallowing
• Feeling of fullness in neck or throat
• Runny nose
• Loss of voice

Diagnosis

Diagnosis of Laryngitis
How is laryngitis diagnosed?
The doctor often makes the diagnosis based on the clinical symptoms. The doctor confirms his diagnosis with –

• History of Upper respiratory tract infection associated with loss of voice
• The patient answers the questions in a hoarse voice
• Examining ears, nose and throat, looking for other potential causes of cold-like symptoms
• Red throat on examination – suggests a streptococcal infection (strep throat) accompanying laryngitis. In such cases the doctor advises a throat swap for a rapid strep test
• In case of chronic hoarse voice, the health care professional would look for more details and an elaborate history

The doctor may interrogate by asking the questions related to:

• Causes leading to GERD – Diet, alcohol use, aspirin, ibuprofen, smoking etc
• Work and hobbies – to find out evidence of repeated chemical inhalation and exposure to air pollution
• Signs and symptoms suggesting the chances of – thyroid disease, stroke or cancers of the head and neck

Tests:
Most laryngitis cases will not require testing to confirm diagnosis.
Chronic laryngitis – Blood tests, X-ray and other diagnostic tests will be suggested – depending on the patient presentation
Laryngoscopy – Most common test performed to look directly at the vocal cords and evaluate their functions
A thin tube containing a lighted fibre-optic camera is inserted through the nose into the back of the throat
It shows inflamed vocal cords, polyps or nodules, movement of vocal cords with breathing and speaking
Indirect laryngoscopy – A mirror is placed in the back of the throat to visualize vocal cords

Risk factors

• Having a respiratory infection such as cold, bronchitis or sinusitis
• Exposure to irritating substances such as cigarette smoke, excessive alcohol intake, stomach acid or workplace chemicals
• Overusing your voice, by speaking too much, speaking too loudly, shouting or singing

Is laryngitis contagious?

• It is contagious only if it is caused by an infection
• Laryngitis, upper respiratory infections and colds are commonly a viral infection spread by aerosol droplets
• Disease transmission can be minimized or prevented by covering the nose and mouth when coughing and sneezing and proper hygiene habits (wash your hands often, don’t share food utensils, wipe down door handles etc)

Differential diagnosis

Acute laryngitis
Chronic laryngitis
Granulomatous laryngitis
Pseudo-myxomatous laryngitis

These signs and symptoms may indicate a croup

Croup – It is an inflammation of larynx and the airway just beneath it. Severe croup symptoms need medical attention. These symptoms also indicate epiglottitis, an inflammation of the tissue that acts as a lid to cover the windpipe (trachea). This can be life-threatening for children and kids.

Complications

Laryngitis can occasionally lead to

• GERD – Repeated episodes of GERD may cause small amounts of acid to get past the inflamed larynx and enter the lung causing recurrent pneumonia or bronchitis
• Pneumonia
• Viral Pneumonia
• Bacterial Pneumonia
• Chronic bronchitis
• Vocal cord paralysis: If the cause of laryngitis is vocal cord paralysis, the swallowing mechanism may also be affected. Food particles may enter the larynx and lungs leading to cough. This also leads to aspiration pneumonia and its accompanying symptoms (fever, cough, shortness of breath) when the food is aspirated deep into the lungs and causes irritation and inflammation of lung tissue

Prognosis

Most cases of laryngitis are viral in origin and / or triggered by a temporary viral infection or voice strain and are not serious. They resolve without treatment with sufficient voice rest.

Laryngitis, hoarseness or breathlessness that lasts for more than 2 weeks may signal a voice disorder.

It should be followed up with a voice pathologist –

• Vocology certified Speech Language Pathologist (SLP)
• Laryngologist (voice specialized ENT)

Imp point:

• Not all individuals who have lost their voice have an infection
• Not all hoarseness is due to a primary inflammation of the vocal cords
• Diphtheria rarely causes laryngitis-like symptoms. People are immunized against Diphtheria but the primary immunization is decreasing. Therefore there exists a potential for new outbreaks. Recent outbreaks of diphtheria have been documented in Russia and Thailand

Laryngitis Ayurvedic Aspect

In Ayurvedic texts, Laryngitis with special reference to hoarseness of voice and partial or temporary loss of voice has been explained in the context of Svara Bheda chapter

Svara Bheda is a word made up of 2 words,

• Svara – means voice
• Bheda – means split / modified / deformed

Thus Svara Bheda means deformed voice which includes hoarseness of voice and loss of voice also.

Svara Bheda is explained in 2 ways:

As a disease – where in hoarseness of voice or loss of voice is the only presenting complaint and it is not dependant on the pathology of another disease. Here Svara Bheda will have its own set of causative factors, pathogenesis, types, signs and symptoms and treatment.

As a symptom – where in hoarseness of voice or loss of voice is one of the symptom complexes of some other disease. Here the Svarabheda is dependent on the pathology of the underlying disease. It will go away once the underlying or primary disease is treated. Svara Bheda also can manifest as Asadhya Lakshana (symptom indicating bad prognosis of a disease) or Upadrava (Complication of a disease) of some other disease.

Let us learn more about Svara Bheda……

Ayurvedic terms

Synonyms (variants): Words resembling or representing (same meaning) Svara bheda used in different contexts –

• Heena svara – Low voice (used in the context of sarpadamsha visha – voice afflicted due to / following snake bite)
• Kshama svara – depleted voice / tired voice (used as a symptom of bad prognosis in dehydration as in diseases Visuchika and Alasaka)
• Ksheena Svara – Decreased voice (mentioned in Vata Kasa – Vata type of Cough)
• Svaropaghata – Damage to voice (mentioned in Asthi-majjagata Kushta i.e. skin diseases manifested at the level of bones and bone marrow)
• Deena svara – Pitiable voice (mentioned in upasargaja trishna – secondary thirst and vataja ashmari – vata type of calculi)
• Ghurghurata – Sore throat (mentioned in Tamaka Shwasa – Bronchial Asthma)
• Krathana – Crying voice (mentioned in Medo roga – obesity)
• Kanta koojana – Suppressed voice (voice limited to throat itself) {mentioned as a symptom in Sannipataja jwara – severe types of fever caused due to vitiation of all the 3 doshas)
• Antargata Svara – Depressed voice / Hidden or latent voice (mentioned in Medoja Svarabheda – Laryngitis caused by morbid fat)
• Kapota iva koojana – Sound or voice resembling that of a pigeon (mentioned in Kshataja Kasa – Cough caused due to injury)
• Kapharuddha Kanta – Throat obstructed by morbid kapha (mentioned in Kaphaja type of Svarabheda)
• Bhinna Svara – Split or broken sound (mentioned in Kshataja type of Kasa – cough caused due to trauma)

The above mentioned variants – point towards the elaborate knowledge and a disciplined approach of Ayurveda stalwarts towards the diagnosis of Laryngitis in various forms and presentations in association with many underlying diseases.

Causes

Svarabheda Causes
अत्युच्चभाषणविषाध्ययनाभिघात संदूषणैः प्रकुपिताः पवनादयश्च।
स्रोतस्तु ते स्वरवहेषु गताः प्रतिष्टां हन्युः स्वरं भवति चापि हि षड्विधः सः॥{यो.र.}

• Atyuchcha Bhashana – Speaking loudly
• Visha – Effect of poisons, toxins etc
• Adhyayana – Reading loudly
• Abhighata – Trauma

Pathogenesis

The Dosha’s (Vata, Pitta and Kapha) vitiated due to the above said causes on gaining entry into the Svaravaha Srotas (Channels responsible for producing and transmitting the sounds and words that we speak – Vocal cords) cause Svarabheda by destroying the voice.

Types

Svarabheda is of 6 types:

• Vataja Svarabheda
• Pittaja Svarabheda
• Kaphaja Svarabheda
• Sannipataja Svarabheda
• Kshayaja Svarabheda
• Medoja Svarabheda

Symptoms

Symptoms of Svarabheda:
Here the name of the disease itself is pointing towards the chief complaint or predominant symptom i.e. Hoarseness of voice or loss of voice.

Vataja Svarabheda Symptoms:
वातेन कृष्णानन मूत्रवर्चा भिन्नं शनैर्वदति गर्धभवत्स्वरं च।{यो.र.}

• Krishna nayana – Blackish discolouration of eyes
• Krishna anana – Blackish discolouration of face
• Krishna mutra – Blackish discolouration of urine
• Krishna varcha – Blackish discolouration of stools
• Bhinna svaram – Split sounds and words when the person speaks
• Vadati gardhabhavat svaram – Speaks with the voice of a donkey

Pittaja Svarabheda Symptoms:
पित्तेन पीतनयनाननमूत्रवर्चा ब्रूयाद्गलेन स विदाहसमन्वितेन।{यो.र.}

• Peeta nayana – Yellowish discolouration of eyes
• Peeta anana – Yellowish discolouration of face
• Peeta mutra – Yellowish discolouration of urine
• Peeta varcha – Yellowish discolouration of stools
• Brooyaat galena vidaaham – Burning sensation is experienced in the throat while speaking

Kaphaja Svarabheda Symptoms:
ब्रूयात्कफेन सततं कफरुद्धकण्ठः स्वल्पं शनैर्वदति चापि दिवा विशेषात्।{यो.र.}

• The throat of the patient is always obstructed by / covered by Kapha (phlegm)
• The patient speaks less and slowly with a feeble voice, especially in the morning

Sannipataja Svarabheda Symptoms:
सर्वात्मके भवति सर्वविकारसंपत्तं चाप्यमसाध्यमऋषयः स्वरभेदमाहुः।{यो.र.}

• The signs and symptoms of all the 3 Doshaja Svarabheda’s (Vataja, Pittaja and Kaphaja Svarabheda’s) are present in a mixed proportion
• This condition is said to have a bad prognosis (impossible to treat)

Kshayaja Svarabheda Symptoms:
धूम्यते वाक् क्षयकृते क्षयमाप्नुयाच्च वागेष चापि हतवाक् परिवर्जनीयः।{यो.र.}

• Smoke is eliminated from the mouth of the patient when he is speaking (patient feels elimination of smoke from his mouth). This gives an impression that the deterioration or destruction of his voice is under progression
• This is also a type of Svarabheda having bad prognosis. Either reject the patient or give some remedy after announcing that the condition is hopeless and impossible to treat

Medoja Svarabheda Symptoms:
अन्तर्गतस्वरमलक्ष्यपदं चिरेण मेदोऽन्वयाद्वदति विदग्धगलतृषार्तः।{यो.र.}

• The words of the patient appears to be sunk deep inside the throat while he speaks (comes out with difficulty)
• The words spoken by the patient is not clear (not understood)
• The words spoken comes out of the throat with a slow pace
• Fat accumulates in the throat (patient feels as if there is a coating of fat in his throat)
• Burning sensation in the throat
• Trishna – Severe thirst

Prognosis

Svarabheda Asadhya Lakshanam (Prognosis of Svarabheda):
क्षीणस्य वृद्धस्य कृशस्य चापि चिरोत्थितो यश्च सहोपजातः।
मेदस्विनः सर्वसमुद्भवश्च स्वरामयो यो न स सिद्धमेति॥{यो.र.}

Svarabheda has a bad prognosis when manifested in:

• Ksheena – debilitated people
• Vriddha – Old aged people
• Krusha – Emaciated people
• Chirotthita – Chronic manifestation
• Sahopajata – Congenital (present since birth)
• Medasvina – Medoja type of (manifested in obese and overweight people) Svarabheda
• Sarvasamudbhava – Sannipataja type of Svarabheda

Treatment principles and medicines

Vataja Svarabheda Treatment

• Sarpihi uparibhuktani – Ghee should be given to drink before food
• Taila – Oils prepared individually – using Bala (Sida cordifolia), Rasna (Alpinia galangal) and Amrita (Tinospora cordifolia) should be administered
• Mamsarasa – Meat soup prepared from the meat of peacock or cock processed in the decoction of Laghu Panchamula (Lesser 5 roots) should be administered
• Maricha-ghritam: After taking food, the patient should be administered with ghee mixed with powder of Maricha (Piper nigrum – Black pepper)
• Kasamarda Ghrita: ghee prepared with Kasamarda juice (Senna occidentalis / Cassia occidentalis) and Bharangi paste (Clerodendrum serratum)
• Bhringaraja Ghrita: Ghee processed with Bhringaraja juice (Eclipta alba)
• Ghee and jaggery mixed with rice should be consumed; later hot water should be taken
• Brahmyadi churnam – Powder prepared from Brahmi (Bacopa monnieri), Mundi (Sphaeranthus indicus), Vacha (Acorus calamus), Shunti (Zingiber officinale) and Pippali (Piper longum) should be used mixed with honey
• Saindhava lavana – Rock salt with sesame oil
• Mayura Ghrita
• Tryushana Ghrita
• Mayura ksheera

Pittaja Svarabheda Treatment

• Virechana – Therapeutic purgation
• Madhura Paya – Milk processed with sweet drugs should be given to drink after Virechana
• Madhura churna – Powder prepared from Sweet tasting drugs should be given mixed in honey
• Sarpi-Guda – Ghee with jaggery
• Yashtimadhu Kashayam – Decoction prepared from Yashtimadhu (Glycyrrhiza glabra) should be given mixed with honey
• Madhura Paya 2 – Milk processed with sweet tasting drugs mixed with sugar and honey should be given for those who have developed hoarseness or loss of voice due to speaking or shouting loudly
• Shatavari Churna – Powder of Shatavari (Asparagus racemosus) should be given mixed with honey
• Bala churna – Powder of Bala (Sida cordifolia) should be given mixed in honey
• Laja churna – Powder of puffed paddy or parched rice should be given mixed in honey
• Madhusarpi – Honey and Ghee mixed in unequal quantities
• Tikta Ghrita (as said in Kushta chapter – chapter dealing with skin disorders and its treatment)
• Jeevaneeya Ghrita (as said in Vatarakta Chikitsa chapter – chapter dealing with Gout and its treatment)
• Vasa Ghrita (as said in Raktapitta Chikitsa chapter – chapter dealing with hemorrhagic disorders and its treatment)

Kaphaja Svarabheda Treatment

• Teekshna Shirovirechana Nasya – Strong nasal purgatives (Nasal drops which cleanse the upper passages by the virtue of their strong and intensive properties)
• Virechana – Therpeutic purgation
• Vamana – Therapeutic emesis (vomiting)
• Dhumapana – Smoking with smoke emitted after burning certain medicinal drugs
• Katu ahara – Foods which have pungent taste
• Yava ahara – Food and dishes prepared using Hordeum vulgare (barley)
• Pippalyadi Churna – Powder prepared from Pippali (Piper longum), Pippalimula (Root of Piper longum), Maricha (Piper nigrum) and Shunti (Zingiber officinale) taken in equal proportions should be given mixed with Gomutra (cow’s urine)
• Yavakshara – Alkali of Hordeum vulgare plant and Katuki churna (Picrorhiza kurroa) mixed with honey

Sannipata Svarabheda Treatment

Ajamodadi Churna:

• The powder prepared from equal quantities of Ajamoda (Trachyspermum ammi / Carum roxburghianum), Haridra (Curcuma longa), Amalaki (Emblica officinalis), Yava Kshara (Alkali of Hordeum vulgare) and Chitraka (Plumbago zeylanica) should be administered with ghee and honey.

Kshayaja, Medoja Svarabheda Treatment

• Kshayaja Svarabheda should be treated on the lines of Kshaya Chikitsa
• Medoja Svarabheda should be treated with medicines having / prepared from drugs having Katu (Pungent), Tikta (Bitter) and Kashaya (Astringent) taste

Raktaja Svarabheda Treatment

Acharya Charaka has explained one more variant of Svarabheda called Raktaja Svarabheda caused by morbid blood.

• Jangala Mamsarasa – Meat soup of the animals and birds living in dry lands should be given after mixing with ghee
• Juices of any one of Draksha (Vitis vinifera), Ikshurasa (Sugarcane) or Vidarikanda (Pueraria tuberosa)
• All treatments explained in the context of Kshayaja Kasa and pittaja svarabheda can be given
• Raktamokshana – Bloodletting

Swarabheda secondary manifestations

The above said are the various types of Svarabheda and their management

Svarabheda can also be a symptom of many underlying diseases (secondary laryngitis). Ayurveda too has mentioned Svarabheda and identified its different forms of manifestation when associated with other diseases. They are as below mentioned –

Ksheena Svara or debilitated voice is found in
Vataja Kasa (Dry and irritating cough caused due to vitiation of Vata).

Kshama svara – Weak voice is found:

• As Asadhya Lakshana (symptom indicating bad prognosis) in Visuchika (pricking pain in abdomen / stomach often compared to cholera) and Alasaka (food stagnation in stomach / lazy stomach), both are the problems of sluggish digestion
• As a symptom of DhatuKshayajanya Daha{Burning sensation occurring due to tissue depletion – Systemic acidosis?}
• As a symptom of Vata dushta stanya – Here, the child drinking the breast milk contaminated by morbid Vata suffers from weak voice

Heena svara – Low voice / Partial Loss of Voice
As an Asadhya Lakshana (symptom indicating bad prognosis) of Sarpadamsha Visha – when a man bitten by snake and afflicted by its poison develops low voice, he will not survive

Bhinna Svara / Svarabheda – Split or broken voice (Hoarseness)
As Samnya Lakshana (generalized symptom) of:

Kasa (cough)

Bala graha – Infective and idiopathic paediatric diseases
As a lakshana (symptom) of:

Kshataja Kasa (cough caused due to trauma)

Vataja Chardi (vomiting caused by morbid Vata)

Shad rupaja Rajayakshma – one among the 6 symptoms of Rajayakshma(Tuberculosis?)

Ekadasha rupaja Rajayakshma – one among the 11 symptoms of Rajayakshma(Tuberculosis?)
As an Asadhya Lakshana (symptom indicating bad prognosis) in:

Rajayakshma (Tuberculosis?)

Galaganda (Cervical tumour / Thyroid enlargement)

Svaropaghata – Destruction of voice or voice damage / Loss of voice
As a lakshana (symptom) of Vataja Pratishyaya (Rhinitis caused by morbid Vata)

Bhinna kamsya patra hata svaraha – Voice resembling the sound of a broken piece of brass / Hoarseness
As a lakshana of Jara shosha (tissue depletion or consumption due to old age)

Deena svara – pitiable sound or voice / voice indicating helplessness:

• As a lakshana (symptom of) in

Upasargaja trishna (severe thirst due to an underlying disease)

Vataja Ashmari (urinary stone formed due to morbid Vata)

Gardhabhavat svara – Voice resembling that of a donkey

• As a lakshana (symptom) of Vataja Svarabheda (Laryngitis or hoarseness caused due to morbid Vata)

Ghurgharakam – bubbling sound / Sore throat

• As a lakshana (symptom) of Tamaka shwasa (Bronchial Asthma)
• As an Asadhya Lakshana (symptom indicating bad prognosis) of Masurika (Eruptive diseases – Small pox)

Krathana – Weeping or crying sound / voice

• As a lakshana (symptom) of Medoroga (obesity / overweight)

Kanta-koojana – Concealed or buried voice (voice buried deep in the throat)

As a lakshana (symptom) in:

• Sannipataja Jwara – Fever manifested due to vitiation of all the 3 Dosha’s
• Alasaka – Lazy stomach
• Apatanaka – Neurological disorder
• Balagraha – Infective or idiopathic diseases of the children

Kapota iva koojana – Sound or voice similar to that of a sparrow

• As a lakshana (symptom) in Apatantraka

Paravata iva koojana – Sound or voice similar to that of a pigeon:

• As a lakshana (symptom) in Kshataja Kasa (Cough caused due to trauma)

Kapharudda kantam svalpam shanaihi vadati – Speaks less and slowly due to the obstruction of kapha (phlegm) in the throat:

• As a lakshana (symptom) in Kaphaja Svarabheda (Laryngitis or hoarseness of voice caused due to morbid kapha)

Antargata svara – Deep concealed voice in the throat (not manifesting)

• As a lakshana (symptom) of Medaja Svarabheda (Laryngitis or hoarseness of voice caused by morbid fat)

The above said diseases should be treated as a prime concern to get rid of Laryngitis. Mere treatment of Laryngitis would not provide good or substantial relief. If the underlying disease is not treated, the symptoms of that disease in question keeps surfacing, Laryngitis is no exception.

Classical formulations

Other classical formulations for Svarabheda in general:

Phalatrikadi Yoga:

• Powder of Triphala (Terminalia chebula, Terminalia bellirica and Emblica officinalis)
• Powder of Trikatu (Piper longum, Piper nigrum and Zingiber officinale)
• Yavakshara – Alkali prepared form Hordeum vulgare plant

The powders of all the above said should be taken in equal proportions and mixed together. This is a useful formulation to alleviate Svarabheda.

Chavyadi Churnam:
The powders of the below said drugs should be mixed in equal proportions and administered for effective cure of Svarabheda (Hoarseness of voice), Peenasa (Cold and congestion), Kapha vikara (Kapha disorders) and Aruchi (Tastelessness) –

• Chavya – Piper retrofractum
• Amlavetasa – Garcinia pedunculata
• Shunti – Zingiber officinale
• Pippali – Piper longum
• Maricha – Piper nigrum
• Tittidika – Garcinia indica
• Talisapatra – Abies webbiana
• Jeeraka – Cuminum cyminum
• Vamshalochana – Bambusa arundinacea
• Chitraka – Plumbago zeylanica
• Twak – Cinnamomum zeylanicum
• Ela – Elettaria cardamomum
• Patra – Cinnamomum tamala
• Guda – Jaggery

Vyaghri Ghrita –

Ghee processed with the below said drugs is said to cure Svarabheda / Svaropaghata (Hoarseness of voice and destruction of voice) and 5 types of Kasa (cough):

• Vyaghri rasa – Juice of Solanum xanthocarpum
• Rasna – Alpinia galangal / Pluchea lanceolata
• Bala – Sida cordifolia
• Gokshura – Tribulus terrestris
• Shunti – Zingiber officinale
• Pippali – Piper longum
• Maricha – Piper nigrum

Pushkaramula churna – Powder of the roots of Pushkara (Inula racemosa)

Svarabheda Pathyam (Good foods):

• Draksha – Vitis vinifera
• Haritaki – Terminalia chebula
• Matulunga – Citrus medica
• Lashuna – Allium sativum
• Saindhava Lavanam – Rock salt
• Ardraka – Zingiber officinale
• Tambula – Piper betle
• Maricha – Piper nigrum
• Ghrita – Ghee

Single herbs

Single herbs used in Svarabheda:

• Ghrita – Ghee
• Matulunga – Citrus medica
• Maricha – Piper nigrum
• Saindhava Lavanam – Rock salt
• Ikshurasa – Sugarcane juice
• Draksha – Vitis vinifera
• Haritaki – Terminalia chebula
• Amlavetasa – Garcinia pedunculata
• Pippali – Piper longum
• Tittidika – Garcinia indica
• Talisapatra – Abies webbiana
• Jeeraka – Cuminum cyminum
• Amalaki – Emblica officinalis
• Ardraka – Zingiber officinale
• Tambula – Piper betle
• Lashuna – Allium sativum
• Vidarikanda – Pueraria tuberosa
• Vyaghri – Solanum xanthocarpum
• Vamshalochana – Bambusa arundinacea
• Chitraka – Plumbago zeylanica
• Twak – Cinnamomum zeylanicum
• Ela – Elettaria cardamomum
• Patra – Cinnamomum tamala
• Guda – Jaggery
• Kasamarda (Senna occidentalis / Cassia occidentalis)
• Bharangi (Clerodendrum serratum)
• Bhringaraja – Eclipta alba
• Yashtimadhu – Glycyrrhiza glabra
• Tulasi – Ocimum sanctum

Useful formulations for Svarabheda:

Kashayam (Herbal decoctions):

• Amrutothara Kashayam
• Vyaghryadi Kashayam
• Dashamula Kashayam
• Dashamulakatutrayadi Kashayam
• Vidaryadi Kashayam
• Drakshadi Kashayam
• Varanadi Kashayam
• Elakanadi Kashayam

Asava / Arishtam:

• Vasarishtam
• Pippalyasavam
• Jirakadhyarishtam

Ghritam:

• Vasa Ghritam
• Rasnadi Ghritam
• Kantakari Ghritam / Vyaghryadi Ghritam
• Vidaryadi Ghritam
• Tiktakam Ghritam
• Jeevantyadi Ghritam
• Saraswatha Ghritam

Vati and Gulika (Tablets): (Click on the medicine names to know more about thme). 

• Khadiradi Bati
• Lavangadi Bati
• Eladi Bati
• Marichadi Bati
• Vyoshadi Bati
• Lakshmi vilasa rasa
• Dhanwantaram Gulika
• Vayu Gulika
• Tribhuvana kirti rasa

Churna (Powders):

• Talisadi Churnam
• Sitopaladi churnam
• Yashtimadhu Churnam
• Laghusuta Mishrana
• Haridra kanda
• Vyoshadi Vatakam
• Giloy Satva

Leham (herbal confections):

• Vasadi leham
• Dashamula rasayanam
• Agastya Haritaki rasayanam
• Chitraka Haritaki rasayanam
• Talisadi leham
• Vidaryadi Leham
• Vyaghryadi leham

Allopathic treatment

General measures:

• Voice rest
• Steam inhalations with – Tincture of benzoin

• Cough suppressants – to reduce cough
• Avoid decongestants – These medications can dry out your throat
• Humidifier or vaporizer – For severe inflammation of larynx. It moistens the air inhaled by the person

• H2-receptor blocker (such as Ranitidine) or Proton-pump inhibitor (such as omeprazole) – To reduce gastric acid secretions in laryngitis caused due to gastro-oesophageal reflux disease
• Steroids – For laryngitis caused by thermal or chemical burns
• Sufficient fluids – In viral laryngitis
• Antibiotic or antifungal therapy – for laryngitis caused due to bacterial or fungal infections
• Surgical procedure and / or speech therapy – in persistent hoarseness or loss of voice due to vocal cord nodules

Area of use of antibiotics and / or steroids:

• Antibiotics: In almost all cases of laryngitis, an antibiotic won’t do any good (because the cause is usually viral). Antibiotic will be prescribed if you have a bacterial infection.
• Corticosteroids: Sometimes they help to reduce vocal cord inflammation

Viral laryngitis:
Treatment is supportive and includes –

• Good hydration – Drink lot of water / fluids
• Humidified air – For breathing
• Patience – Allow vocal cords to rest and recover

Laryngitis with significant pain and difficulty in swallowing –
Short course of steroids to decrease inflammation, to shorten the course of symptoms

Croup –
Dexamethasone – Single dose given orally (Decadron, DexPak) or by intramuscular injection

Chronic laryngitis –
Treatment depends on the cause of inflammation or loss of function
Discontinuation of smoking and alcohol has a positive effect

References

http://www.medicinenet.com/laryngitis/article.htm
http://www.mayoclinic.org/diseases-conditions/laryngitis/basics/definition/con-20021565
https://en.wikipedia.org/wiki/Laryngitis
http://www.webmd.com/cold-and-flu/tc/laryngitis-topic-overview

Laryngitis or hoarseness of voice may just look like a simple complaint but it may be a tree developing on the roots of a more serious systemic disease. You have the best remedies for Laryngitis in Ayurveda. But don’t forget to consult an Expert Ayurveda Doctor for an opinion before starting on with anything because self-medication might be harmful.
Take timely action to get rid of your Laryngitis…You need your lovely voice to tell…to express…everything!!!
Consult Dr Raghuram Y.S. MD (Ay)